Integrating the Healthcare Enterprise

1. Integrating the Healthcare Enterprise Cross-enterprise Document Sharing for Imaging (XDS-I) Rita Noumeir Ph.D. University of Quebec IHE Technical and Planning Committees IHE Interoperability Workshop

2. Abstract / Scope • Sharing of Imaging Information across health enterprises • Imaging Information includes • extensive sets of DICOM instances including images, evidence documents and presentation states • diagnostic reports provided in a "for display" form • selection of diagnostically significant images associated with the report content IHE Interoperability Workshop

3. Value Proposition • Imaging component of the Electronic Health Record: Shared imaging Record, in a community, region, etc. • Effective means to contribute and access imaging documents across health enterprises. • Scalable sharing of imaging documents between radiology departments, private physicians, clinics, long term care, acute care with different clinical IT systems. • Easy access: Care providers are offered means to query and retrieve imaging documents (images and reports) of interest. IHE Interoperability Workshop

4. Value Proposition • Distributed: Each Care delivery organization “publishes” imaging information for others. Actual images remain in the source/Image Manager. • Cross-Enterprise: A Registry provides an index for published information to authorized care delivery organizations belonging to the same clinical affinity domain. • Document Centric: Published clinical data is organized into “clinical documents”. using agreed standard document types (DICOM KOS, PDF and/or text report) • Document Content Neutral: Document content is processed only by source and consumer IT systems. • Standardized Registry Attributes: Queries based on meaningful attributes ensure deterministic document searches. IHE Interoperability Workshop

5. XDS-I Dependencies • XDS-I depends on IT Infrastructure Cross-Enterprise Document Sharing (XDS) • Actors are required to support XDS • Document Source • Document Consumer • Document Registry • Document Repository • Documents, and metadata are specialized IHE Interoperability Workshop

6. XDS-I Actors / Grouping • Sharing of an Extensive DICOM set • Document Source shall be grouped with an Image Manager/Image Archive • Sharing of a report that references selected images • Document Source shall be grouped with an Image Manager/Image Archive • Sharing of a report that references selected images from previously published extensive DICOM set • Document Source can be grouped with a Document Consumer IHE Interoperability Workshop

7. XDS-INew Transactions • RAD-Y1 Provide and Register Document Set • ITI-14 Register Document Set • ITI-16 Query Registry • ITI-17 Retrieve Document • ITI-18 Patient Identity Feed • RAD-Y6 WADO Retrieve IHE Interoperability Workshop

8. XDS-ITransaction Diagram IHE Interoperability Workshop

9. XDS-I Required Transactions • Document Consumer • at least one Retrieve (DICOM C-Move) • Document Source • RAD-Y1 Provide and Register Document Set • Document Repository • nothing specific to XDS-I • Document Registry • nothing specific to XDS-I • Image Manager / Image Archive • RAD-Y6 WADO Retrieve IHE Interoperability Workshop

10. XDS-IOptions • Document Source, at least oneof the following options • Extensive Set of DICOM Instances • PDF Report • Text Report • Multipart Text/PDF Report IHE Interoperability Workshop

11. Sharing of Extensive DICOM Instance Set IHE Interoperability Workshop

12. Register Manifest Query Registry DICOM Manifest DICOM Manifest Retrieve Manifest Reference to image 1 Reference to image 1 Reference to image 2 Reference to image 2 Reference to image 3 Reference to image 3 Retrieve Images Manifest Manifest Manifest Manifest Manifest Clinical IT System Clinical Encounter Document Registry Document Repository IHE Interoperability Workshop

13. Extensive DICOM Instance Set IHE Interoperability Workshop

14. Sharing of Extensive DICOM Instance Set • The shared Document is a manifest • a Key Object Selection DICOM Instance • Image Manager/Image Archive is required • to ensure that the referenced images from within a published manifest are available to be retrieved • Document Source is responsible • for replacing a previously submitted manifest Document when a change occurs to the manifest content (eg. Change of the DICOM SOP instances refrenced wihtin the manifest) IHE Interoperability Workshop

15. Sharing of Imaging Report IHE Interoperability Workshop

16. Radiology Report Header: Report Type: OB / Gyn BPD ….. ... Findings: ….. Gestational Impressions: Age ... Text Report PDF Report Text +PDF Report Radiology system Report Source IHE Interoperability Workshop

17. Register Report Query Registry Radiology Report Header: Report Type: OB / Gyn BPD Retrieve Report ….. ... Findings: ….. Gestational Impressions: Age Report Report Report ... Clinical IT System Clinical Encounter Document Registry Document Repository Radiology system Report Source IHE Interoperability Workshop

18. Imaging Report IHE Interoperability Workshop

19. Sharing of Report • The shared Report Document format is • PDF, Text, or multipart PDF + Text • A report can • embed selected images in its PDF format • include fully resolved hyperlinks (interactively clickable) that point to the selected images • Document Source is responsible • for formatting the hyperlink to reference relevant images as a DICOM WADO URI or as IHE RID Request for Document • Document Source is required • to ensure that image references are valid links IHE Interoperability Workshop

20. Linking Report to Complete Set of Images SubmissionSet DocumentEntry DocumentEntry Manifest Report Document Registry Document Repository IHE Interoperability Workshop

21. Linking Report to Complete Set of Images SubmissionSet 1 SubmissionSet 2 DocumentEntry Manifest Report Document Registry DocumentEntry Document Repository IHE Interoperability Workshop

22. Linking Report to Prior Images and Prior Report SubmissionSet 3 SubmissionSet 1 SubmissionSet 2 SubmissionSet 4 DocumentEntry DocumentEntry DocumentEntry DocumentEntry Manifest Prior Manifest Prior Report Report Document Registry Document Repository IHE Interoperability Workshop

23. Linking Report to Selected Images BPD ... ….. Radiology Report Header: Report Type: OB / Gyn ….. Findings: Gestational WADO URI Link to image Age ... Relevant Image Radiology system Report Source IHE Interoperability Workshop

24. XDS-I Metadata • eventCodeList • R2 instead of Optional • Code for Acquisition Modality from DCMR Context Group CID 29 and • Code for Anatomic Region from DCMR Context Group CID 4 • typeCode • Requested Procedure Code of the Requested Procedure, to which the shared document is associated IHE Interoperability Workshop

25. IHE Web site: http://www.ihe.net http://www.himss.org/IHE http://www.rsna.org/IHE http://www.acc.org/quality/ihe.htm Technical Frameworks Technical Framework Supplements – Trial Implementation 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 More information…. Questions? IHE Interoperability Workshop