IHE Radiology Domain 2007 Update

1. IHE Radiology Domain 2007 Update Ellie Avraham – Kodak Health Group IHE Radiology Technical and Planning Committees

2. Scheduled Workflow Charge Posting Presentation ofGrouped Procedures Teaching Files & Clinical Trials Export Reporting Workflow Patient Info. Recon-ciliation Post-Processing Workflow KeyImageNotes Simple Image & Numeric Reports Consistent Presentation ofImages NMImage EvidenceDocs Access to Radiology Information Portable Data for Imaging XDS for Imaging Audit Trail & Node Authentication - Radiology Option IHE Radiology Integration Profiles Mammography Image Image Fusion Import Reconciliation Workflow Nuclear Medicine Image Radiologist / Technologist Communication

3. IHE 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 May 2007 – Trial Implementation June 2007

4. Technologist and Radiologist Communication 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.

5. Technologist and Radiologist Communication – 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.

6. Technologist and Radiologist Communication – 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.

7. IHE 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

8. IHE Reporting 2.0 - 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

9. Radiology Reporting Workflow • The 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.

10. National 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

11. National Extensions: Spain • Support the Character set for ISO Latin 1 • Patient Identification – Use 2 Family names • Patient Insurance Status • Patient Contact data: Mail, Email, Phone,..

12. National 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.

13. Modifications in Scheduled Workflow Image Manager Image Archive ADT ↓Pt. Registration [RAD-1] ↓Patient Update [RAD-12] 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] DSS/Order Filler Order Placer ↓ Procedure Scheduled [RAD-4] ↑ Image Availability Query [RAD-11] ↓ Procedure Updated [RAD-13] ↑ Performed Work Status Update[RAD-42] ↑ Instance Availability Notification [RAD-49] Bold Modified Bold + Underline New Plane Optional Plane Unchanged

14. National Extensions: Japan • Use 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

15. 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 October-December 2007

16. 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?