September, 2005 What IHE Delivers

IHE Radiology Domain IHE Radiology Domain 2007 Update2007 Update

Ellie Avraham – Kodak Health GroupEllie Avraham – Kodak Health Group

IHE Radiology Technical and Planning CommitteesIHE Radiology Technical and Planning Committees

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IHE Radiology Integration ProfilesIHE Radiology Integration Profiles

Patient Info.

Recon-ciliation

Access to Radiology Information

Consistent Presentation

ofImages

Audit Trail & Node Authentication - Radiology Option

EvidenceDocs

KeyImageNotes

Simple Image & Numeric Reports

Presentation of

Grouped Procedures

Post-

Processing Workflow

Reporting Workflow

Charge Posting

XDS for Imaging

NMImage

Scheduled Workflow

Teaching Files & Clinical

Trials Export

Portable Data for Imaging

Mammography Mammography ImageImage

Image Image FusionFusion

Import Import Reconciliation Reconciliation WorkflowWorkflow

Nuclear Nuclear Medicine Medicine ImageImage

Radiologist / Radiologist / Technologist Technologist CommunicationCommunication

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IHE Radiology 2007 - Work PlanIHE Radiology 2007 - Work Plan

Technologist and Radiologist Communication Profile

National Extensions: Canada, Spain, Japan

Radiology Reporting Content – White Paper

Radiology Reporting Workflow – White Paper

Radiology profiles utilizing HL7 v2.5 – White Paper

Public Comments Public Comments May 2007May 2007 – Trial Implementation – Trial Implementation June 2007June 2007

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Technologist and Radiologist Technologist and Radiologist Communication Profile RationalCommunication Profile Rational

Currently, technologists cannot see markups in the acquisition room that radiologist applies to images at the diagnostic workstation unless special hardware is purchased and placed in the acquisition room.

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Technologist and Radiologist Technologist and Radiologist Communication – Use Case 1Communication – Use Case 1

Radiologist decides that extra views are necessary on a patient while reading a mammogram.

The radiologist applies text and or graphic markups on the images to indicate the location of the potential lesion and to indicate which additional views to perform.

The technologist opens the case with the markups, reviews the images and performs the requested additional views.

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Technologist and Radiologist Technologist and Radiologist Communication – Use Case 2Communication – Use Case 2

While performing a mammogram, the technologist has a question that requires input from the radiologist prior to the patient leaving the acquisition room.

The tech applies text and or graphic markup to the images.

The radiologist reviews the images and markups and gives instructions to the tech as to how to finish the study.

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IHE Reporting 2.0IHE Reporting 2.0 Issue/current state: there are a multitude of encodings, transport

mechanisms and applications/use cases for each of the different types of data in the reporting chain

Key points to address:• What are recommended/permitted/deprecated encodings for each

type of data• What are recommended/permitted/deprecated transport mechanisms

for each type of data• When/where are encoding translations and/or transport bridges

appropriate/inappropriate Have created a reporting task force that crosses domains, though need

more participation from most outside domains Objective for this year is to research and produce a whitepaper Depending on progress and ability to achieve consensus, the objective

for next year or the following would be a scoped profile proposal

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IHE Reporting 2.0IHE Reporting 2.0 - Content - Content Proposal will need to allow for a phased progression – practical for today yet

providing the guidance and flexibility for the future

1 - Text blob: Report = blahblahblah

2 - Text chunks: Observations = blahblah, Findings = blahblah, etc

3 - Text snippets: Reason = blah, Diagnosis = blah,

4 - Coded: Reason = x12, Diagnosis = y43, Finding1 = ... Current high level thoughts:

• DICOM SR within department: Evidence Documents like Key Image Notes• HL7 CDA once leave the department• Remaining question of what actor performs the translation, when, and where

in the workflow Have only scratched the surface – still need to take into account the existing

combinations that are being used as well as many more peripheral use cases (e.g. quality measures, data mining, publishing to national registry, etc.)

Templates will be developed for the conversion between SR and CDA

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Radiology Reporting WorkflowRadiology Reporting WorkflowThe Current Reporting Workflow (RWF) and Post Processing Workflow (PWF) will be Simplified and optimize.

The new DICOM Supplement 96, “Undefined Worklist and Procedure Step” will be used to simplify the Reporting Workflow Management, and support both the Push and Pull models Workflow. Which means that the Reporting work items will be accessible in both methods: either by Pushing the work items from the Workflow Manager to the Workstations or Pulling the work items by the Radiologist from the Workflow Manager Worklist.

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National Extensions: CanadaNational Extensions: Canada Extended DICOM Character Sets - The Specific Character Set (0008,0005) Attribute shall contain the value “ISO_IR 100” in order to select ISO 8859/1 Latin-1 characters.

Extended HL7 Character Set - The Field MSH 18 shall contain the value “8859/1” in order to select the ISO 8859 Latin-1

Public health identifier (PHI) – In HL7 should be located in PID-3 and in DICOM it should be located in the tag (0010,1000).

Extension and Translations of Physician Types in PV1

PV1-19 (Visit Number) is an identifier for the visit or consult episode.

The 'D’ value, should be added to the PV1-2 (Patient Class) for Day hospitalization.

Extend the PID-16 (Marital Status), adding the G for Living Together in the Marital Status table.

Syntax Rules for PID-5 (Patient Name) - Last name prefix will be used for names with « particule ».

Translation of Specific Fields of the PID Segment

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National Extensions: SpainNational Extensions: SpainSupport the Character set for ISO Latin 1

Patient Identification – Use 2 Family names

Patient Insurance Status

Patient Contact data: Mail, Email, Phone,..

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National Extensions: JapanNational Extensions: Japan More detailed order information is needed Patient arrival is important event Support for medical billing system is required Extension for SWF and CHG integration profiles

Proposed 2 New Transactions- Patient Accepted/Arrival Notification [RAD-X], using HL7 ORU message - Order Performed Notification [RAD-Y], using HL7 OMI message for Billing

purposes

Affected Existing Transactions- Register Patient [RAD-1] & Patient Update [RAD-12]– Utilize only A08 event.- Placer Order Management [RAD-2] – HL7 OMG message is used instead of

ORM. Detail information is set in ORC segment by using JJ1017 Code - Filler Order Management [RAD-3] become optional and can be substituted by the

new transaction: Order Performed Notification [RAD-Y]- Procedure Scheduled [RAD-4] – HL7 OMI message is used from DSS/OF to

IM/RM, ORI used for reply from IM/RM to DSS/OF and ORM message is not being used

- Procedure Update [RAD-13] – HL7 ORM message is not used.

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Modifications in Scheduled WorkflowModifications in Scheduled Workflow ADT

DSS/Order Filler

Order Placer

Pt. Registration [RAD-1]↓Patient Update [RAD-12]↓

←Placer Order Management [RAD-2]→Filler Order Management [RAD-3]→Appointment Notification [RAD-48]→Patient Accepted Notification [RAD-X]→Order Performed Notification [RAD-Y]

↓Pt. Registration [RAD-1]↓Patient Update [RAD-12]

↓ Procedure Scheduled [RAD-4] ↑ Image Availability Query [RAD-11] ↓ Procedure Updated [RAD-13] ↑ Performed Work Status Update[RAD-42] ↑ Instance Availability Notification [RAD-49]

ImageManager

ImageArchive

Bold ModifiedBold + Underline NewPlane OptionalPlane Unchanged

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National Extensions: JapanNational Extensions: JapanUse of Start Block Control Characters like 0b

Use of HL7 Messages

- Use of ADT/ACK Messages between Order Placer and Image Manager

- Use of OMG/ORG Messages for the interfacing HIS – RIS

- Use of OMI/ORI Messages for exam and procedure information

- Use of ORU/ACK Messages for Patient Arrival

Use of HL7 Message Segments

- MSH segment is required for each message of requested order

- The EVN Segment is used for backward compatibility

- Request PID segment in each order information for one patient.

- PV1 segment is used for distinction between outpatient and inpatient

Use of HL7 Data Types

- PV2 segment is not being used in Japan.

- TQ1 segment is required

- TQ2 and DSC segments are not being used in Japan

- ZE1 Segment for Billing

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IHE Radiology 2008-2009 Work Plan IHE Radiology 2008-2009 Work Plan

Updating Radiology Reporting Content Profiles

Updating Radiology Reporting Workflow Profile

Mammography Workflow Profile

Updating Profiles to HL7 v2.5

Updating Charge Posting profile

Planning Decisions Planning Decisions October-December 2007October-December 2007

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More information….More information….

IHE Web site: www.ihe.net

Technical Frameworks & Supplements Radiology TF v7.0

Non-Technical Brochures :• Calls for Participation• IHE Fact Sheet and FAQ• IHE Integration Profiles: Guidelines for Buyers• IHE Connect-a-thon Results• Vendor Products Integration Statements

Questions?

Questions?

September, 2005 What IHE Delivers