DICOM & IHE: What Are They, and Why Do We Need Them?

1. RSNA 2002 DICOM & IHE: What Are They, and Why Do We Need Them? Sanjay Jain Director, Engineering, Cerner Corporation Co-Chair, IHE Planning Committee RSNA 2002

2. What Is DICOM • Digital Imaging and COmmunications in Medicine • Began with ACR-NEMA initiative in late 1980s (also known as DICOM 2) • Defines standard method to transfer images and related information between devices manufactured by various vendors • DICOM 3.0 was introduced in 1992 with 9 parts, now there are 16 parts RSNA 2002

3. The DICOM Standard • Each part has a specific purpose • Part 2 : Conformance Statement • Part 4 : Service Class Specification • Part 6 : Data Dictionary • Part 10 : Media Storage and File Format for data interchange • Part 14 : Gray Scale Standard Display Function RSNA 2002

4. The DICOM Standard (contd.) • Defines Communication Protocol and content structure • Service Requested (e.g Modality Worklist) • Message structure and encoding (big endian, little endian) • Tag Value pair for identifying information, regardless of the transaction • Patient Name: (0010,0010) – Group 0010, Element 0010 • Patient ID: (0010,0020) – Group 0010, Element 0020 RSNA 2002

5. Why DICOM? • Imagine if film from your camera could not be processed by neighborhood store but only a special agency • How timely would your pictures be available? • Will you keep on using the camera? • You want to process it easily and quickly. • It was the same situation in Imaging • DICOM enabled exchange of digital imaging and textual information using a Common Communication Protocol • But left interpretation for implementers, so? RSNA 2002

6. Where do you use DICOM? • Digital Scanners (CT, MR, CR, DR, etc.) • Picture Archival and Communication System (PACS) • Softcopy Display and Reading systems (Workstations) • Film Printers • Others… How do you know if your scanner can save to the PACS? RSNA 2002

7. DICOM Conformance Statement • It is a detail document explaining implementation of DICOM standard in the Product • Defines the service classes implemented and the role that system plays (SCP or SCU) for each class. E.g. ProVision implements Modality Worklist as an SCP • Required to compare when reviewing systems for connectivity • Need a technical staff person RSNA 2002

8. Patient Care Workflow Enter patient as J Doe HL7/ DICOM HL7 DICOM examination orders for J Doe report HIS RIS modality worklist for J Doe RSNA 2002

9. HL7 and DICOM • They are both important for healthcare and digital imaging • The information communicated using HL7 is typically Patient, Encounter, Procedure, Charges • Same information is useful for Imaging process But how does information flow between systems implementing two standards? RSNA 2002

10. Communication Challenges Systems need Information other systems have But, systems communicate poorly or not at all Result: - tedious, inefficient workflows - data that is inconsistent or unavailable Responsibility for information flow between systems and between departments, is often unclear RSNA 2002

11. Integrating the Healthcare Enterprise • 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: • Improved Information Flow • Advanced Multi-System Functions RSNA 2002

12. Who is IHE? • Participants: • Professional Societies (RSNA/HIMSS/…) • Vendors (over 30 companies) • Standards Group Committee Members • RSNA and HIMSS sponsor IHE to provide a neutral forum for working on the Big Picture RSNA 2002

13. What Does IHE Do? • Users and vendors work together to identify and design solutions for integration problems • Intensive process with annual cycles: • Identify key healthcare workflows and integration problems • Research & select standards to specify a solution • Write, review and publish IHE Technical Framework • Perform cross-testing at “Connectathon” • Demonstrations and Education at tradeshows (RSNA/HIMSS) RSNA 2002

14. Key IHE Concepts • Generalized Systems -> Actors • Interactions between Actors -> Transactions • Problem/Solution Scenarios -> Integration Profiles RSNA 2002

15. Key IHE Concepts • For each Integration Profile: • the context is described (which real-world problem) • the actors are defined (what systems are involved) • the transactions are defined (what must they do) RSNA 2002

16. IHE Integration Profiles Post- Processing Workflow Patient Information Reconciliation ChargePosting Schedule, perform, & notify image processing & CAD steps Collection of billable procedure details Unknown patients and unscheduled orders Consistent Presentation of Images Key ImageNotes Simple Image and Numeric Reports Simple reports with image links and, optionally, measurements Hardcopy and softcopy grayscale presentation state Flag significant images Presentation of Grouped Procedures Subset a single acquisition Access to Radiology Information Consistent access to images and reports Basic Security Audit Trail Consolidation & Node Authentication Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps RSNA 2002

17. Where is IHE going? • Further Expansion in Radiology • Handling multiple Archives within the institution • Horizontal Expansion to • IT Infrastructure (Enabling EMR) • Desktop Integration • Cardiology • Geographical Expansion to • Europe (Germany, France, UK, Italy) • Japan • … RSNA 2002

18. How do You benefit from IHE? • Clinical Users • Greater access to more consistent information • Fewer errors, fewer tedious tasks • Buyers • Specify/purchase integration capabilities easily • Freedom to acquire your selection of systems • IT Professionals • Faster, more predictable integration projects • Administrators • Increased throughput • Better scheduling and tracking RSNA 2002

19. What IHE is NOT • It is not a Standard • Has produced a Framework • Defines consistent and unambiguous use of standard • It is not a Product • Can’t buy IHE as a product • Ask for IHE integration profile implemented in Actors/Products you buy • It may be an upgrade, a feature or an option in the product • It is not an Organization • Is an initiative RSNA 2002

20. DICOM & IHE: What Are They, and Why Do We Need Them? Can you have an integrated Enterprise Without Them? RSNA 2002

21. Resources • medical.nema.org • www.rsna.org/IHE • FAQs • Integration Profiles • Primer on IHE • Presentations • IHE Technical Framework Thank You RSNA 2002