Who’s who Harry Solomon Jan 2012 HL7 Working Group Cytometry Meeting.
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Transcript of Who’s who Harry Solomon Jan 2012 HL7 Working Group Cytometry Meeting.
2 /Harry Solomon /
Jan 2012HL7
CytometryMeeting
Interoperability Standards Development Organizations (SDO’s)
3 /Harry Solomon /
Jan 2012HL7
CytometryMeeting
Four level model of “use” in interoperability
business process : tasks exchange : mail
data record : documentterminology : words
Workflow
Messaging
Format
Vocabulary
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Jan 2012HL7
CytometryMeeting
Vocabulary for lab tests and observationsResponsive for new tests/measurements
Vocabulary for medicine, anatomy, procedures, clinical findingsRobust concept model
Workflow
Messaging
Format
Vocabulary
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Jan 2012HL7
CytometryMeeting
General organization for cytometry; standards committee
Focused on cytometry research, small standards group
Example standards:• Data File Standard for Flow Cytometry (FCS)• Minimum Information about a Flow Cytometry
Experiment• Image Cytometry Experiment Format (proposed)
Workflow
Messaging
Format
Vocabulary
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Jan 2012HL7
CytometryMeeting
Standards for clinical labs
Mostly process quality specifications, some interoperability specs
Example standards:• Laboratory Automation: Communications With
Automated Clinical Laboratory Systems, Instruments, Devices, and Information Systems
• Laboratory Automation: Data Content for Specimen Identification
• Point-of-Care Connectivity
Workflow
Messaging
Format
Vocabulary
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Jan 2012HL7
CytometryMeeting
Interoperability standards for healthcare
Broadest healthcare standards organization, robust information modeling framework
Example standards:• HL7 v2 ADT (Patient Demographics), Orders,
Observations (Results), Lab Automation Control• HL7 v3 Reference Information Model• Clinical Document Architecture• Electronic Health Record Functional Model
Workflow
Messaging
Format
Vocabulary
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Jan 2012HL7
CytometryMeeting
Interoperability standards for medical imaging
Supports bulk binary data, persistent object model, department workflow, universally implemented in radiology
Example standards:• Microscopic Image, Whole Slide Image• Modality Worklist / Performed Procedure Step• Storage Commitment
Workflow
Messaging
Format
Vocabulary
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Jan 2012HL7
CytometryMeeting
Integrating the Healthcare Enterprise, a pubilc-private collaboration promoting standards-based interoperabilityUse cases from professional society participants (CAP, NAACCR) drive implementation guides, Connectathons, demonstrationsExample standards:• Anatomic Pathology Workflow Profile• Physician Reporting to Public Health – Cancer
Registry• Cross-Enterprise Document Sharing Profile
Workflow
Messaging
Format
Vocabulary
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Jan 2012HL7
CytometryMeeting
Cooperation
HL7 cooperative agreements / MoU’s / affiliations with all other SDO’s
HL7 & DICOM – Joint Working Group (IIWG/WG-20) meets at 3 annual HL7 WGMs
DICOM & LOINC / IHTSDO – DICOM submits proposed concepts for coding
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Jan 2012HL7
CytometryMeeting
HL7 v2 Messaging Standard: What
HL7 Messaging Standard - An Application Protocol for Electronic Data Exchange in Healthcare Environments
Enables disparate healthcare applications to exchange clinical and administrative data
Defines the data content and provides the layout of messages that are exchanged between applications based upon a particular trigger event
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Jan 2012HL7
CytometryMeeting
HL7 Version 2 Messaging
SENDINGAPPLICATION(Patient Administration)
RECEIVINGAPPLICATION(Lab System)
ADMIT MESSAGE (A
DT)
ACKNOWLEDGEMENT (ACK)
TRIGGER EVENT:Patient is Admitted!
PID attributesSEQ ELEMENT NAME1 Set ID - Patient ID2 Patient ID3 Patient ID List4 Alternate Patient ID5 Patient Name6 Mother’s Maiden Name7 Date/Time of Birth8 Sex9 Patient Alias
ETC.
….PID|||12345||Lorenzi^Virginia||19811231|F…
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Jan 2012HL7
CytometryMeeting
HL7 specification terms
Message - an ordered collection of segments, associated with a trigger eventTrigger event - a real world cause for the exchange of dataSegment - an ordered collection of data elements that typically share a common subject• Specifies whether the data element is required or optional and
whether it may repeat.
Data element - a unit of exchanged meaning, with a data type and suggested length, and possibly a table of valid valuesData types - encoding of meaning in a constrained character string, or constructs of component data types• Limited to two levels of defined construct (components,
subcomponents)
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CytometryMeeting
Example HL7 v2 ADT Message
MSH|^~\&|ADMIN|MCM|LABADT|MCM|198808181126|SECURITY|ADT^A01^ADT_A01|MSG00001|P|2.4| <cr>EVN|A01|198808181123||<cr>PID|1||PATID1234^5^M11^ADT1^MR^MCM~123456789^^^USSSA^SS||JONES^WILLIAM^A^III||19610615|M-||C|1200 N ELM STREET^^GREENSBORO^NC^27401-1020|GL| (919)379-1212| (919)271-3434||M||PATID12345001^2^M10^ADT1^AN^A|123456789|9-87654^NC|<cr>NK1|1|JONES^BARBARA^K|WI^WIFE||||NK^NEXT OF KIN<cr>PV1|1|I|2000^2012^01||||004777^LEBAUER^SIDNEY^J.|||SUR||-||ADM|A0-|<cr>
Patient William A. Jones, III was admitted on August 18, 1988 at 11:23 a.m.His wife, Barbara K. Jones is a related family member (next of kin).He has been assigned to room 2012, bed 01 on nursing unit 2000.To be attended by doctor Sidney J. Lebauer (ID# 004777) for surgery.
Character based, similar to mag tape records
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CytometryMeeting
Example HL7 v2 ADT Message
MSH|^~\&|ADMIN|MCM|LABADT|MCM|198808181126|SECURITY|ADT^A01^ADT_A01|MSG00001|P|2.4| <cr>EVN|A01|198808181123||<cr>PID|1||PATID1234^5^M11^ADT1^MR^MCM~123456789^^^USSSA^SS||JONES^WILLIAM^A^III||19610615|M-||C|1200 N ELM STREET^^GREENSBORO^NC^27401-1020|GL| (919)379-1212| (919)271-3434||M||PATID12345001^2^M10^ADT1^AN^A|123456789|9-87654^NC|<cr>NK1|1|JONES^BARBARA^K|WI^WIFE||||NK^NEXT OF KIN<cr>PV1|1|I|2000^2012^01||||004777^LEBAUER^SIDNEY^J.|||SUR||-||ADM|A0-|<cr> Message
Type – 3 char code for the type of message sent
Trigger Event – 3 char code for the real world event causing the message
Segment Type – 3 char code for the logical group of information
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Jan 2012HL7
CytometryMeeting
HL7 implementation architecture
“The Standard is written from the assumption that an event in the real world of healthcare creates the need for data to flow among systems. The real-world event is called the trigger event.”
“HL7 does not explicitly support, but can be used with, systems that support store and forward and data broadcast facilities.”
HL7 push model issues• Handling multipoint ACKs• Offline systems
Typical implementation withstore and forward interface engine
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Jan 2012HL7
CytometryMeeting
v2 Table of Contents
Chapter 1 - IntroductionChapter 2 - Control (Conformance added v2.5)Chapter 3 - Patient AdministrationChapter 4 - Order EntryChapter 5 - Query (in Chap 2 in v2.2-v2.3.1)Chapter 6 - Financial ManagementChapter 7 - Observation ReportingChapter 8 - Master Files (added v2.2)Chapter 9 - Medical Records (Document Mgmt) (added v2.3)Chapter 10 - Scheduling (added v2.3)Chapter 11 - Patient Referral (added v2.3)Chapter 12 - Patient Care (added v2.3)Chapter 13 - Clinical Laboratory Automation (added v2.4)Chapter 14 - Application Management (added v2.4)Chapter 15 - Personnel Management (added v2.4)Chapter 16 - eClaims (added v2.6)Chapter 17 - Materials Management (added v2.6)
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Jan 2012HL7
CytometryMeeting
HL7 Clinical Document Architecture
The scope of the CDA is the standardization of clinical documents for exchange.
A clinical document is a record 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.
A CDA is not an isolated finding or measurement, or an aggregation of documents
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Jan 2012HL7
CytometryMeeting
Key Aspects of the CDA
CDA documents are encoded in Extensible Markup Language (XML)
CDA documents derive their meaning from the HL7 v3 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; allows document management, compilation of an individual patient's clinical documents into an electronic patient record
• Body contains narrative text / multimedia content (level 1), optionally structured into sections with coded titles and tagged narrative content (level 2), optionally augmented by coded equivalents to narrative (level 3)
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Jan 2012HL7
CytometryMeeting
CDA Release 2 Information Model
Header Body
ParticipantsSections/Headings
Clinical Statements/Coded Entries
ExtlRefsContext
Doc ID&Type
StartHere
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Jan 2012HL7
CytometryMeeting
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.
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Jan 2012HL7
CytometryMeeting
Narrative and Coded Info
CDA structured body 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
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Jan 2012HL7
CytometryMeeting
Implementation Guides
CDA is a very generic structure focused on human-readable content• Great for minimally marked-up documents• Not much required to render narrative
content
Machine processing (more powerful apps) requires standardization of CDA structures and entries• Implementation guides for specific clinical
uses• Templates for documents, sections, entries
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Jan 2012HL7
CytometryMeeting
PCC Technical Framework
EDR
Continuity of Care Document Ancestry
HL7 RIMData TypesVocabulary
CDA
CRS
CCR
CCD
ClinicalStatement
Model
XDS-MS(R3)
C32
APS
EDES
FSA
2004 - 2006
1998 - 2004
2002 - 2005
2003 – 2007
O&ODomainModelGenomicsDomainModelPatient Care
DomainModel
Other DomainModels
2005 - 2006
2005 - 2006
2006 - 20072006 -
2007
2006 - 2007
C37
2006 - 2007
ASIG
1999 - 2007
XDS-MS (R1)
2006 - 2007
2006 - 2007
2006 - 2007
2007 - 2008
2007 - 2008
2007 - 2008
CDA4CDT
2007
XD*-LAB
QED
2007 - 2008XPHR
C83
C80
2008
Inherits from
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Jan 2012HL7
CytometryMeeting
CDA Consolidation
Need one-stop shop for CDA templates
Consolidated CDA implementation guide incorporating HL7, IHE, and Health Story projects
Funded by ONCHIT
Basis for care coordination interoperability under Meaningful Use Stage 2 incentives (2014)
Balloted through HL7 May 2011, Approved as DSTU December 2011
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Jan 2012HL7
CytometryMeeting
Scope of DICOM Standard
The International Standard for Medical Imaging and related information
Standard object formats for images, waveforms, derived structured data (measurements and assessments)
Workflow management in the imaging department
Service-based network protocol over TCP/IP; media interchange
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Jan 2012HL7
CytometryMeeting
DICOM Key Features
Object-oriented, persistent information objects
Tagged data elements, binary encoding
Client-server network services, service negotiation
Image compression by encapsulation
Conformance Statements
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Jan 2012HL7
CytometryMeeting
DICOM Image Information Object Definition
PatientModule
PatientStudy
Module
GeneralSeriesModule
GeneralStudy
Module
Frame ofReferenc
eModule
GeneralEquipme
ntModule
GeneralImageModule
ImagePlane
Module
Contrast/
BolusModule
ImagePixel
Module
ModalityImageModule
Multi-frame
Module…
VOILUT
Module
SOPCommonModule
PatientInformation
StudyInformation
SeriesInformation
Image(Instance)
Information
Patient NamePatient ID
Patient SexPatient Birthdate
Study Unique ID
Accession NumberStudy
Date/TimeStudy
DescriptionReferring MD
Rows/ColumnsBits per PixelPhotometric
DICOM Composite
Information Model
Hierarchy
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Jan 2012HL7
CytometryMeeting
DICOM Network Services
Information object exchange
Reliable object storage (commitment)
Object repository (PACS) query / retrieve
Modality worklist query
Performed procedure step status notification
Image print
Application protocol riding on TCP/IP
(at same level as FTP, HTTP)
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Jan 2012HL7
CytometryMeeting
Data Element Encoding
0020000DhexUI 1.2.840.1.113709.9.0.0.5743.14575602.126hex
Study InstanceUnique Identifier
(0020,000D)
Instance UID encoded as “dotted decimal”
Data Set
Data Element
Tag Value Length Value Field
optional field - dependent on negotiated Transfer Syntax
ValueRepresen
-tation
Data Elem. Data Elem.Data Elem. Data Elem.
order of transmission
Attributes are the logical concepts associated with an information entity
Data elements are how attributes are encoded in an information object
Similar to TIFF
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Jan 2012HL7
CytometryMeeting
Part of a DICOM object(0008,0005)
CS30
ISO 2022 IR 13\ISO 2022 IR 87
(0008,0008)
CS22
ORIGINAL\PRIMARY\AXIAL
(0008,0016)
UI26
1.2.840.10008.5.1.4.1.1.2
(0008,0018)
UI58 1.2.392.200036.9116.2.6.1.48.12393615.1211874194
.564494
(0008,0020)
DA8
20080527
(0008,0021)
DA8
20080527
(0008,0022)
DA8
20080527
(0008,0023)
DA8
20080527
(0008,0030)
TM10
163836.000
(0008,0031)
TM10
164306.390
(0008,0032)
TM10
164039.850
(0008,0033)
TM10
164040.397
(0008,0050)
SH8
5162581
(0008,0060)
CS2
CT
(0008,0070)
LO8
TOSHIBA
…
(7FE0,0010)
OW52428
800 00 00 00 ff ff ff ff 00 0f 4c 4a 49 46 00 01...
Tags in increasing numeric orderValue length always an even numberAttributes related to modules and
information model levels NOT contiguous
PatientInformation
StudyInformation
SeriesInformation
Image(Instance)
Information
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Jan 2012HL7
CytometryMeeting
The Service-Object Pair (SOP) Class
The unit of interoperability and conformance
Service: network function between user (client) and provider (server)
• Store (transfer), query, move, create, notify …
∴ SOP Classes represent functionality on information objects
• Store a CT image • Store an MR image• Find (list) all studies for a patient • Find the worklist for a
modality• Move a set of images • Create an image print job• Request/Notify the secure storage of images• Notify the performance of a procedure step
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Jan 2012HL7
CytometryMeeting
DICOM Network Negotiation
First step application level handshake in setting up Association (network connection)
Agreement on SOP Classes, roles (client/server), image compression, security
One message roundtrip (initiator to acceptor and back)
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Jan 2012HL7
CytometryMeeting
Storage Commitment
“Object Storage” is basic DICOM service for network transfer of images – but has no required receiver behavior• C-STORE acknowledgment simply means the objects were
received whole• Objects can be successfully received by an image archive
system, but a system failure could cause them to be lost prior to reliable storage
Storage Commitment provides an explicit acknowledgment of reliable storage of specific objects• The sending system can then safely delete objects from local
store, e.g., auto-purge
Storage Commitment may incur a substantial delay• E.g., after overnight copy to tertiary storage
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Jan 2012HL7
CytometryMeeting
Storage and Storage Commitment
Modality Transmits Images (or other Objects) to PACS:
C-STORE transfer of images (acknowledged)
Modality Issues Storage Commitment Request to PACS:
N-ACTION including List of objects to be committed (acknowledged)
PACS Notifies Modality of Success (or Failure) :N-EVENT-REPORT including List of objects committed (acknowledged)
PACSModality
③
①
①
②
②③
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Jan 2012HL7
CytometryMeeting
DICOM Query/Retrieve
Allows a system to query another system for a list of available images (query)
Also allows a system to request another system to send images (retrieve)
Query Request
Retrieve Request
Image(s) Send
Store Response(s)
Retrieve Response
Query Match(es)PACS
Query/RetrieveSCP
Query/RetrieveSCU
Workstation
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Jan 2012HL7
CytometryMeeting
Managed Workflow Concepts
PROCEDURE STEP : The smallest unit of managed workin the workflow
Scheduled Procedure Step: ‘A unit of work to do’Performed Procedure Step: ‘A unit of work done’
ORDER : A request for departmental service
REQUESTED PROCEDURE : Unit of work resulting in one Report
with associated codified, billable acts
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Jan 2012HL7
CytometryMeeting
Workflow structuring is user oriented
ORDER:A request for departmental service
(Accession Number)
REQUESTED PROCEDURE : Unit of work resulting in one Report
with associated codified, billable acts(Requested Procedure ID)
PROCEDURE STEP :The smallest unit of managed
workin the workflow
(modality worklist entry)
CLINICIANOR REFERRING DOC:
The Imaging Dept Customer
RADIOLOGIST/ PATHOLOGIST :
In Charge of producing the Report
TECHNOLOGISTIn charge of
acquiring images, etc.
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Jan 2012HL7
CytometryMeeting
Simple Workflow
One Order – One Procedure – One Study – One Report
AcquisitionModality
ORDERA request for DepartmentalService
Imaging Department
Set of Codifiab
le,Billable,
Acts
One or more series of images
PerformedProcedure
StepRequestedProcedure
ScheduledProcedure
Step
Report
DICOMModality Worklist
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Jan 2012HL7
CytometryMeeting
AcquisitionModality
AcquisitionModality
Multiple Modality Steps
ORDERA request for DepartmentalService
Imaging Department
Set of Codifiab
le,Billable,
Acts
One or more series of images
PerformedProcedure
Step P1
ScheduledProcedure
Step B
RequestedProcedure
ScheduledProcedure
Step A
Report
One or more series of images
PerformedProcedure
Step P2
DICOMModality Worklist
DICOMModality Worklist