Transcript DICOM_and_IHE_by_Cor_Loef.ppt

DICOM and IHE,
Integrating the Healthcare
Enterprise
Cor
CorLoef
Loef
Program
Manager
Interoperability
Co-chair
DICOM
Strategic
Advisory Committee
Philips
Medical
Member IHE
Planning
andSystems
Technical Committee
Contents
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Goal of IHE
IHE process
Integration Profiles and the role of standards in IHE
DICOM’s use in the IHE Integration Profiles
Current topics
Questions and answers
May 5, 2002
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Integration Hell in
the Enterprise
RIS /
HIS
• Different information islands:
Modalities, PACS, HIS, RIS,
Modalities
EPR
PACS
• Different standards and
information models :
DICOM, HL7, XML
EPR
• Different (proprietary)
interpretations and
implementations
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Goal of IHE
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It’s an initiative promoting and supporting the
integration of systems in the healthcare
enterprise
Integration Goal: Improve the efficiency and
effectiveness of clinical practice by:
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Improved Information Flow
Advanced Multi-System Functions
With minimal “integration project pain”
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IHE process
• Users and vendors work together to identify and
design solutions for integration problems
• Intensive process with annual cycles:
– Identify key workflows and integration problems
– Research & select standards to specify a solution
– Write, review and publish Technical Framework
– Perform cross-testing at “Connectathon”
– Demonstrations at tradeshows:
RSNA/HIMSS, and also JFR, DRK, JMCP
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The (multi-vendor) Integrated
Imaging Solution
Modalities
Image
Server
Radiology
Information
System
Diagnostic
Workstation
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Web
Distribution
Connection to
other Network
and/or
TeleRadiology
CD
Exchange
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Role of standards in IHE
• IHE attacks real world radiology integration
problems
• Standards such as HL7 and DICOM provide
dictionaries
• IHE defines a “phrasebook” that solves real
world problems by assembling pieces
provided by DICOM/HL7
• IHE is also a way to promote and advance
the implementaion of standards
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IHE: Relation to Standards
Integration
Solution
C
B
A
IHE
Technical Framework
Selection of options
DICOM
May 5, 2002
Common
information
model
HL 7
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Use Case Roles &
Interaction Diagrams
Actor 1
Actor 2
Actor 3
• Examples of Actors:
- ADT / Patient Registration
- Acquisition Modality
TRANSACTIONS
Actor 1
Actor 2
Message 1
• Examples of Transactions:
Actor 3
- Register Patient
- Images Stored
Message 2
Message 3
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Goal of IHE
IHE process
Role of standards in IHE
DICOM’s use in the IHE Integration Profiles
Current topics
Questions and answers
May 5, 2002
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IHE Integration Profiles
• Integration solution for real-world integration
problems
• Set of related transactions among systems
• Allow buyers to focus on high-level
integration, cornerstone for defining
requirements in RFP’s
• Implementation is defined by the IHE Technical
Framework
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Year 4 Integration Profiles
Scheduled Workflow
Admit, order, schedule, acquire
images, notify of completed steps
Patient Information
Reconciliation
Post- Processing
Workflow
Unknown patients and
unscheduled orders
Schedule, perform, &
notify image processing
& CAD steps
Charge Posting
Collection of billable
procedure details
Consistent Presentation
of Images
Key Image
Notes
Simple Image and
Numeric Reports
Hardcopy and softcopy
grayscale presentation state
Flag significant
images
Simple reports with image
links and, optionally,
measurements
Presentation of Grouped
Procedures
Subset of a single acquisition
Access to Radiology Information
Consistent access to images and reports
Basic Security
Audit Trail Consolidation & Node Authentication
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1.Scheduled Workflow
report
report
report
Registration
Report
DICOM:
Repository
HIS patient • Modality Worklist Query Requirements,
Film
Diagnostic
information
with Acquisition Protocol Setting optionWorkstation Lightbox
images
• Required attribute mapping fromPACS
retrieved
Worklist to Images
• Modality Performed Procedure Step,
Orders Placed
procedure
with Exception Management
option
RIS
scheduled
Image Manager
Prefetch any relevant
• Store
and Archive
examination orders
prior studies
•Storage Commitment
Modality images
modality
Orders Filled
worklist
Patient and procedure
information retrieved
by the modality
acquisition
acquisition
completed
in progress
May 5, 2002
stored
acquisition
completed
images
printed
Film
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2. Patient Information
Reconciliation
Enter patient
as J Doe
HIS
J Doe
Patient later
identified enter proper
data
Reports stored
for Network
Access
Emergency
Registration
update
patient info
Orders Placed
Registration
Images and Exam
data presented for
diagnosis
PACS
images
retrieved
update
patient info
RIS
examination orders
for J Doe
Orders Filled
update
patient images
modality worklist
for J Doe
acquisition
completed
May 5, 2002
report
Image Manager
and Archive
Modality
J Doe
images
stored
acquisition
completed
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3. Consistent Presentation
of Images
What the Radiologist
Displays:
Area Of
Interest
Annotate
What the Reviewing
Physician Sees:
Original Image
& Presentation State
&Grayscale Standard
The Radiologist’s
Transformations Are
Saved
Area Of
Interest
Prepared Image
Zoom
Flip
Original Image
Window Level
Original Image
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The Radiologist’s
Transformations Are
Lost
Original Image
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4. Presentation of Grouped
Procedures
Head
View
Requested
Procedure:
Report:
HEAD
HEAD
RIS / PACS
Requested
Procedure:
Chest
View
CHEST
MODALITY
Performs a
single exam
Operator
groups
2 procedures
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Head
View
Report:
CHEST
DICOM:
• Presentation State
• Modality Performed
Procedure Step
Chest
View
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5. Simple Image and Numeric
Report
Goal:
Accurate, complete report
accessible whenever the
referring physician desires
Report Verification
DICOM:
• Basic Text SR
• Enhanced SR
• Template TID 2000
• Codes from DCMR
Verified Report
Preliminary Report
Images and Exam
data presented for
diagnosis
Report stored
for Network Access
Report & Images
retrieved
Report and Image
Review for Patient Care
Images
retrieved
Image Manager
and Archive
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6. Key Image Notes
Radiologist
Flags Images:
Referring Physician
Sees Key Images First:
Note1
for refering physician
This image shows
the renal rupture.
Note1
Note1
for refering physician
This image shows
the renal rupture.
For referring
physician:
This image shows
the renal rupture.
Note2
For referring
physician:
This image has
the hematoma.
May 5, 2002
Study &
Key Image Notes
Note2
for refering physician
This image has the hematoma.
Note2
for refering physician
This image has the hematoma.
DICOM:
• Key Object Selection
Document SOP Class
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7. Access to Radiology
Information
Emergency
Department
Referring
Physician
Radiology DICOM:
Department – • C-FIND with required
Images and
matching and return keys
Reports
• C-MOVE
• Images and SR
Remote
Clinics
Electronic
Medical
Record
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Other Departments:
- Oncology
- Surgery
- Neurology
- Pediatrics
- etc.
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8. Charge Posting
ADT
Account
Management
DSS/
Order Filler
Charge Posted
Reporting
Completed
PPS In Progress/
Completed
Acquisition
Modality
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Charge
Processor
DICOM:
• required billing info in
MPPS
• Film consumption
Report
• Procedure
Manager Type
• Supplies and devices
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9. Basic Security
• Local access control (authentication of user)
• Strong authentication of remote node (digital certificates)
• network traffic encryption is not required
• Audit trail with:
• Real-time access
• Time synchronization
Secured System
Secured System
Secure network
System A
System B
DICOM:
• Basic TLS Secure
Transport Connection Central
Audit Trail
Profile
Repository
• well-known port 2762
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10. Post-Processing Workflow
PostProcessing
Manager
PP worklist
Provided
PP Workitem Claimed
PP Workitem Completed
PP PPS Started
PP PPSDICOM:
Completed
Image
Creator
May 5, 2002
• General Purpose Worklist
• Images
• Evidence Documents:
• Mammography CAD SR
• Basic Text SR
• Enhanced SR
• Comprehensive SR
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10. Post-Processing Workflow:
use case
Acquisition
Modality
Image
Manager
MPPS Complete
Department Scheduler/
Post-Processing Manager
Image Creator
Create Worklist Item
Store Images
Post-Processing WL Provided
Post-Processing Task Claimed
Query/ Retrieve Images
Post-Processing PPS Started
Creator Images Stored
Post-Processing PPS Completed
Post-Processing Task Completed
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Goal of IHE
IHE process
Integration Profiles and the role of standards in IHE
DICOM’s use in the IHE Integration Profiles
Current topics
Questions and answers
May 5, 2002
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Current topics
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Reporting workflow
Security Standard for Audit Records
Extension to other clinical domains: Cardio, NM
Desktop Integration
May 5, 2002
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Integration:
back-office and/or front-office
Back-Office
Clinical
Information
System
messages
Integrated
Clinical Viewing
at the desktop
Front Office
May 5, 2002
Efficiency
Clinical
Information
System
Improve
Clinical
Decisions
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CCOW approach
A Federated System of Context-Managed Applications
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Integration:
the EPR approach
HIS
Other
Clinical
System
RIS
Cardiology
PACS
Radiology
PACS
Electronic Patient Record
May 5, 2002
VL, US, NM
PACS
Header:
Thorax
Report
Type:
…..
…..
…..
Findings:
Mass
…..
….. Daim.
Conclusions:
Infiltr.
…..
…..
Ima
(Poi
gn
e t
Re
e r
f )
s
.
:
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DICOM and IHE,
Integrating the Healthcare
Enterprise
Questions?
May 5, 2002
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