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Displayable Reports Dirco van Norden
Autumn meeting 2011
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Mission Rogan-Delft
• Medical market • International standards (DICOM, HL7, IHE) • Zillion Suite
o Independent o Together with products of other vendors o Create solutions for specific situations
1988: PACS (1993, 1st in standardization) 2007: XDS-I (2008, IHE profiles Registry/Repository/Source/Consumer) 2009: RIS (2010, IHE profiles PIR/SWF) Q1 2012: VNA
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DICOM SR vs. HL7 CDA
DICOM SR
• DICOM Structured Reporting
• The scope of DICOM SR is the standardization of documents in the imaging environment.
• SR documents are encoded using DICOM standard data elements and leverage DICOM network services (storage, query/retrieve)
• DICOM SR is used in key subspecialty areas that produce structured data in the course of image acquisition or post-processing, where: – Leveraging the DICOM infrastructure is easy and desirable
– Results should be managed with other study evidence
• Examples – Sonographer measurements
– Computer-aided detection results
– QC notes about images – Radiation dose reports
DICOM SR Example
HL7 CDA
• Clinical Document Architecture
• The scope of the CDA is the standardization of clinical documents for exchange.
• 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.
• Both machine-readable and human-readable.
• CDA documents can be displayed using XML-aware Web browsers or wireless applications such as cell phones.
• Consistent format for all clinical documents
– Diagnostic and therapeutic procedure reports
– Encounter / discharge summaries
– Patient history & physical
– Referrals
– Claims attachments
HL7 CDA Example
DICOM SR vs. HL7 CDA
• DICOM SR and HL7 CDA – SR strength in robust image-related semantic content (Evidence Document)
– CDA strength in human readable narrative report (Report)
• Various methods for integration
– DICOM committee published a document for mapping DICOM SR to CDA for migration (Supplement 135).
– Referencing CDA documents from within DICOM objects, and vice versa
• CDA now viewed as a primary format for diagnostic imaging reports.
• DICOM SR will see continued and expanding use for Evidence Documents created in the imaging setting.
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IHE Profile Displayable Reports
Facts
Displayable Reports (DRPT) • Specifies transactions supporting creation, transmission and reading of reports.
• Provides linkage between report, the imaging and evidence of the procedure.
• Provided for broad distribution.
• Graphical content support with PDF and CDA.
• Transcending specialism's (Cardiac, Radiology …).
Benefits
• Rich data model allows inclusion of previously unavailable info
• Accurately convey the findings to the referring physician – Links to images belonging to report (picture = 1000 words) – Reflect the competence of the radiologist
• Legal record of imaging exam – Radiologist signature
• Structured data makes ‘secondary use’ possible – More accurate billing
– Teaching and research
• Consistent approach to handling report creation and management
– Interoperability Competition Innovation
– Purchase best of breed reporting applications
• Mechanism for archiving reports in PACS
Benefits • Distribution
– Easy to render reports at browser level – No need to change the client, even when you changed the structure of the report
DRPT Support in PACS/RIS
PACS
Reporting application
RIS
• Reporting applications on image display workstations create reports in a displayable format (PDF or CDA)
• RIS systems manage the report signature cycle, storage, and distribution
• PACS systems may store, manage, and/or display the reports – f.e. by CDA embedded in DICOM
• Image display systems may query, retrieve and display reports from the PACS using DICOM
• Other clinical workstations may retrieve and display reports from the departmental data store (the PACS or RIS)
CDA DICOM
CDA
DRPT Support anywhere
• Distribution
• Transcending specialism’s
• Digital Message Switchboard
– Tool to convert HL7 ORU into CDA structured document and submit it to XDS
PACS
Digital Message
Switchboard
Affinity Domain
ORU
CDA
XDS
Referrer
Consumer
XDS
Hospital
Source / Consumer
RIS
CDA
CDA
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Questions
Interoperability showcase C68
Rogan-Delft Booth B68
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