IHE Eye Care “Evidence Documents”

IHE Eye Care“Evidence Documents” IHE Workshop 2006 - Changing the Way Healthcare Connects Donald Van SyckleDVS Consulting, Inc. Jim Riggi, CTO Medflow, Inc. Co-Chair IHE Eye Care Technical Committee

Evidence Documents • An extension of the Eye Care SWF profile(i.e. actors must support SWF before supporting Eye Care ED) • Measurements, observations and coded data created using DICOM objects • Typically created by either an Acquisition Modality or Evidence Creator(i.e. eye care instruments, standalone workstations, EMRs, etc.)

Evidence Documents • Produced during acquisition or post-processing workflows • May be Interpreted along with imagesor stand alone • Either DICOM Structured Reports (SR) or DICOM Encapsulated PDF

Eye Care EvidenceDocuments Examples • Glaucoma progression analysis performed on visual field analyzers • RNFL analysis performed on an OCT device • Measurements on fundus images • Measurements on anteriour chamber OCT images for phakis IOL implantation planning • Corneal ablation planning based on corneal topography maps • Others….

DICOM Structured Report (SR) • The DICOM object used by IHE for reporting • Reports that include actual measurement values, observations and/or coded data to describe eye care evidence • Eye Care specific DICOM SRs being defined by WG9 – IHE will adopt upon completion • Keratometer, Autorefractor, Lensometer, biometry, visual fields Note: Fundus measurements may be possible using Simple Image and Numeric DICOM SR, but has yet to be reviewed by WG9

Eye Care ExtensionDICOM Encapsulated PDF • Also includes measurement values, observations and/or coded data to describe eye care evidence • However, DICOM Encapsulated PDF is a “display only” solution • Is used when no specific DICOM SR solution is defined Note - since there are no current DICOM SRs defined for Eye Care, it is expected that only DICOM Encapsulated PDF will be used in the AAO showcase

Query / Retrieve Evidence Document Stored Storage Commitment Evidence Documents

Evidence Documents Professional Report Eye Care Header: Report Type: …… ….. Retinal.. Findings: ... ….. Interpretation ……. Impressions: … ... Image Refs.: Images

Managed Like Images • Evidence Documents can be transferred, stored, and query/retrieve just like images • Exists in the same study as images Patient Information Patient ID Study Information Study Inst. UID Series Information Series Information Series Information Series Information Series Inst. UID Image DICOM Encp. PDF OtherComposite IODs SR Evidence Document SOP Inst. UID

Patient Imaging Serv. Req. (Order) RequestedProcedure Study Study Mgt ScheduledProcedure Step PerformedProcedure Step Series Series ED Image Image ED Image ED a Part of Performed Procedure Step` A PPS is an “Atomic Imaging/Measurements Exam” • A PPS Starts and Ends. It is never resumed ! • A PPS produces one or more series of images/evidence documents • Once a PPS is completed, images/evidence documents cannot be added to a series • Additional PPS can always be performed • A Study usually holds the work product for a Requested Procedure • A Study may be multi-modality (I.e. multiple instruments)

Workflow

Example – Acquisition Modality • Images have been taken at an Acquisition Modality • After image acquisition, the Acquisition Modality performs post processing such as: • a glaucoma progression analysis • RNFL analysis performed on an OCT device • Others….. • Evidence Documents are created using DICOM SR or DICOM Encapsulated PDF • Evidence Documents are: • stored in the same Study as the images (in a separate series) • tracked using DICOM MPPS • sent to the storage server • securely stored using Storage Commitment

Example – Workstation, EMR • Unscheduled post-processing done after the acquisition, products support both the Image Display Actor and Evidence Creator Actor • Use DICOM query/retrieve to acquire previous images and/or measurements then perform post-processing • measurements on fundus images • corneal ablation planning based on corneal topography maps • measurements on anterior chamber OCT images for phakic IOL implantation planning • Others… • Evidence documents are: • either DICOM SR or DICOM Encapsulated PDF • stored in the same study as created by the Acquisition Modality • sent to the storage server • securely stored using Storage Commitment

IHE Generic Keys for Query Retrieve of:- Images- Evid. Doc.- SR R = Required and the SCU shall be able to display R+ = IHE Requirement on top of DICOM

Extension for PDF Query • How to store, query, retrieve for Evidence Documents is defined by SWF • DICOM SR queries for Evidence Documents have been defined by radiology • Eye Care added the storage and query for DICOM Encapsulated PDF • Added a new display field for the Image Display actors from query, the PDF “Document Title”

More information…. • IHE Web site: www.ihe.net • Technical Frameworks • ihe_eyecare_tf_TI_vol1_2006_06_01 (Trial Implementation version) • ihe_eyecare_tf_TI_vol2_2006_06_01 (Trial Implementation version) • ihe_tf_rev6.0ft_vol1_2005-05-18-FINAL (Radiology) • ihe_tf_rev6.0ft_vol2_2005-05-18-FINAL (Radiology) • ihe_CARD_tf_vol2_2.1_FT (Cardiology) • Standards used by IHE Eye Care • DICOM Standardwww.nema.medical.org • HL7 Standardwww.hl7.org • IHEConnectathon Oct. 2006 at RSNA HQ • IHEShowcase at Nov. 2006 AAO Conference • Vendor Products Integration Statements

IHE Eye Care “Evidence Documents”