RADIOLOGY IT 2011

What to see at the RSNA annual meeting?

David S. Mendelson, M.D.

Professor of Radiology

Chief of Clinical Informatics

The Mount Sinai Medical Center

Co-chair IHE International Board

Major Radiology IT Themes- Meaningful Use for the Radiologist Radiation Exposure

Aggregating and monitoring patient and population exposure

Image Sharing Quality Diminished inappropriate utilization IHE XDS; Personal Health Records as a vehicle

Reporting Decision Support Teaching and Research

MIRC CTP IHE- TCE

Radlex as a fundamental tool Playbook

Meaningful Use – ONC/CMS

RSNA Informatics Radiology

Informatics Committee (RIC)

RSNA Annual Meeting

IHE Showcase (Technical Exhibit floor)

Scientific Sessions Scientific Posters /

Education Center Vendors

IHE Connectathon 2011

Radiation Exposure Evaluating legacy dose information

OCR solutions Evaluating dose today

Within the institution Comparing multiple instruments

Patient Site comparison

IHE-REM profile ACR registry

Site to Site comparison as well as within an enterprise

Radlex terms

REM Actors and Transactions to move dose information stored as DICOM SR

REM

MIRC - Teaching Files

Ease of installation Brand new user interface - more

intuitive, easier to operate TCE compatible - of course!! Improved conferencing

capabilities Automatic conversion utility to

bulk import entire static image collections into the system with a few clicks

Medical Imaging Resource Center

CTP- Clinical Trials Processor

Again, ease of installation and configuration

Best anonymizer in the business! Audit trail repository - 21CFR11

compliance for FDA- work in progress Plug-in architecture, customizable

pipelines Extremely efficient - will easily

process millions of images De-facto image management tool for

NCI and other large trials

TCE- Teaching File and Clinical Trial Export

IHE profile

How to get images directly out of PACS as a part of your normal workflow

TCE

Image Selector

Image Exporter

Receiver

TCE

TCE – Actors and Transactions

Reporting Structured reporting

Standardization of content

Quality Data mining Decision support Trigger events

RSNA Templates Incorporation of

RADLEX

RADLEX The Radlex playbook for CT

orderables will be released by the annual show

The ACR Dose Registry is employing the Radlex ontology for its exam dictionary

ideally a site would use this exam dictionary

the ACR has a tool to map other exam dictionaries to the RADLEX playbook

IMAGE SHARING

•Version 1.1 is in production

•Review and Update 2011

IHE-XDS (Cross-Enterprise Document Sharing)

XDS.a XDS- I.a XDS.b

?? XDS-I.b

a vs. b Related to web

standards and transactions

XDS-I

A Standards Based Solution

NIBIB/RSNA Image Sharing Project

Goals of Contract NIBIB contract Bootstrap an IHE based network

Primary emphasis is Consumer Control through PHRs

Can be extended to other forms of sharing HIE

Security and Confidentiality are drivers

Replacement / Alternative to CD

NIBIB contract summary Consumer Control

Employ IHE solutions whenever possible

IHE generally has not focused on consumer- driven solutions, but rather on institutional and enterprise workflow

5 Academic Institutions Mayo Clinic Mount Sinai Medical

Center University of California

San Francisco University of Chicago University of Maryland

Establish a clearinghouse

Engage PHRs 300,000 patients over

2 years

Image Sharing/Elements of Solution

Edge Server Register a patient Listens to a Radiology Information System (RIS) - looking for

a complete exam Retrieves Image set from PACS and Report from RIS Send both to clearinghouse

PHI hidden; an RSNA ID and 2nd factor security token are used to identify the patient

Clearinghouse (XDS-I) – functions as a secure router Transiently hold encrypted patient data

PHR Consumer controls upload and future access

Must have RSNA ID available and know answer to 2nd factor question

Develop web based viewers Download full DICOM data set

Misc Consumers

Project design assumptions

Security is paramount Restrictive policy PHI is never unsecured

Consumer controls the flow of information by placing it in the PHR Diminishes the need for BAAs

between enterprises Imaging Site to Clearinghouse Clearinghouse to PHR

Image Enabled PHR

Report

Future Directions

Refine Workflow Initial workflow is to replace a CD Exam updates Download DICOM data and archive

in a local PACS Edge server as a platform

Radiation Monitoring Peer Review Quality Metrics

Live Q&A SessionDavid MendelsonProfessor of Radiology & Chief of Clinical

Informatics

The Mount Sinai Medical Center; Co-chair IHE

International Board

david.mendelson@mountsinai.org

Mary TierneyVP, Chief Content Officer, Health Imagingmtierney@healthimaging.com

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