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DICOM Strategy

Explore trends in imaging-IT strategy, collaboration with SDOs, and achieving workflow efficiency through DICOM standards. Learn about horizontal and vertical integration for improved healthcare workflow.

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DICOM Strategy

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  1. DICOM Strategy Cor Loef co-chair DICOM WG10:Strategic Advisory Committee Philips Medical Systems

  2. Scope of DICOM Charter WG10: Strategic Advisory Cmt Trends in Imaging-IT Strategy Planning process Collaboration with other SDOs Contents IHE @ RSNA 2002

  3. Mission of DICOM Create and maintain international standards for communication of bio-medical diagnostic and therapeutic information Goals of DICOM Achieve interoperability and improve workflow efficiency between imaging systems and other information systems Scope of DICOM IHE @ RSNA 2002

  4. To develop and maintain the long-term strategic plan of the DICOM Standards Committee. URL: http://medical.nema.org/dicom/geninfo/dicom_strategy To review standards and technology trends in healthcare, biomedical imaging, commerce, telecommunications, and informatics; To consider issues and opportunities related to the strategic evolution of DICOM; To provide liaison to other standards developing organizations: ISO, HL7, JIRA, CEN Charter of WG10 IHE @ RSNA 2002

  5. Scope of DICOM Charter WG10: Strategic Advisory Cmt Trends in Imaging-IT Strategy Planning process Collaboration with other SDOs Overview IHE @ RSNA 2002

  6. Quality of care improved by information and IT: All relevant information the care giver and patient need, anywhere and anytime, for the best clinical decisions through one common and simple user interface, adapted for the task. IHE @ RSNA 2002

  7. IHE @ RSNA 2002

  8. Horizontal Integration Vertical Integration HIS Other Clinical System RIS Web based PACS Cardiology PACS VL, US, NM PACS Radiology PACS Web distribution At the desktop Trends in Imaging-IT: Active workflow Paradigm shift IHE @ RSNA 2002

  9. HIS HIS IMAGING: IMAGING: ADT Patient Registration • • PACS / Archives PACS / Archives Patient Registration • • Workstations Workstations Image Creator • • Modalities Modalities Order Placer Image Display New Order Q /R Images Department System Scheduler – Order Filler – Image Archive Procedure Scheduled Image Manager Images Stored Storage Commit PPS In-Progress / Completed Acquisition Modality RIS RIS Modality Worklist Vertical Integration The Healthcare Enterprise IHE @ RSNA 2002

  10. Active Workflow IHE @ RSNA 2002

  11. Registration Preparation Examination Post Examination ..010011... ..010011... ..010011... ..010011... ..010011... ..010011... ..010011... ..010011... Archiving ..010011... ..010011... ..010011... Referral Reviewing Image Distribution Demonstration Transcription Reporting Workflow in Radiology Digital Radiology IHE @ RSNA 2002

  12. Active Workflow Personalized Work list For each user IHE @ RSNA 2002

  13. User’s default display protocol IHE @ RSNA 2002

  14. Yesterday Paradigm shift in PACS:Clinical Applications to PACS IHE @ RSNA 2002

  15. Multi-slice CT: 1000+ images IHE @ RSNA 2002

  16. Viewing & Advanced Image Processing: clinical SW packages move towards modalities, PACS and web Post-Processing everywhere 3D Spine Cardiac MR Endo3D IHE @ RSNA 2002

  17. Analysis tools to enhance clinical decisions: Echo measurements & calculations Left Ventricular Analysis Quantitative Coronary Analysis Vascular X-Ray Analysis Vascular X-Ray Post-Processing IHE @ RSNA 2002

  18. Horizontal Integration Hospital Information System, Master Person Index Radiology workflow Cardiology workflow Ultrasound workflow Pathology workflow Radiology PACS Cardiology PACS Ultrasound PACS Visible Light PACS One Image Management Infrastructure IHE @ RSNA 2002

  19. Image (information) management system supports archiving/retrieving of all types of clinical objects (incl. visible light) and Structured Reports Horizontal Integration IHE @ RSNA 2002

  20. RIS data Header: Thorax Report Type: ….. ….. ….. Report Creator application Findings: Mass (DICOM) SR Object ….. ….. Daim. Conclusions: Infiltr. ….. ….. Image Refs.: From DICOM standard: Report Templates DICOM SR Creation - Example -Radiology Image data (Pointer) from PACS select Coding Schemesbehind pop-up menus IHE @ RSNA 2002

  21. Web Viewer Webserver PACS Viewing Station At Modality Web based PACS IHE @ RSNA 2002

  22. Web and Security Web Viewer Webserver Security PACS Viewing Station At Modality IHE @ RSNA 2002

  23. Image Management system and Departmental Information Systems must be EHR-prepared (Query/Retrieve) EHR: emphasis today on visual integration on the desktop, will become the integrated, secure, patient centric, source of health information Need for coded vocabularies to represent medical knowledge and the patient’s health condition Web front-end: viewing not only of images but also waveforms, measurements, reports, lab results, etc need the capability to access the original medical images support for (DICOM) Structured Reporting XML and XML Schema for the exchange of clinical documents “Electronic Health Record” IHE @ RSNA 2002

  24. Back-Office Clinical Information System Clinical Information System messages Integrated Clinical Viewing at the desktop Front Office EHR: Visual Integation Efficiency Improve Clinical Decisions IHE @ RSNA 2002

  25. Scope of DICOM Charter WG10: Strategic Advisory Cmt Trends in Imaging-IT Strategy Planning process Collaboration with other SDOs Overview IHE @ RSNA 2002

  26. In recent meetings WG10 has identified quite a number of strategic topics in the following domains: data acquisition, imaging technology post-processing and presentation object management and archiving data and result distribution treatment planning workflow management Strategic planning process IHE @ RSNA 2002

  27. The (multi-vendor) Integrated Imaging Solution Connection to other Network and/or TeleCardiology Image Archive Image Server Department Info Server CD Exchange Diagnostic Workstation IHE @ RSNA 2002

  28. Quality of Patient Care Effective treatment plan Fast and accurate diagnosis Images Waveforms Measurements Order Report Treatment plan Diagnose Collect and present Reduce Errors Codes and vocabularies Codes and vocabularies Persistent Object Ref Structured Presentation IHE @ RSNA 2002

  29. Topics in Acquisition domain: Workflow outside the Radiology domain: RT, VL, Cardio. Requires specialized workflow. Refreshing the worklist, event based. Amount of data generated, kind of data generated. More, 3D, real-time, grayscale, color, time-sequence, text Text really broadens the scope: evidence documents, key image note, codes, vocabularies, templates. Need for simple, small documents, e.g. just a few measurements Amount of data will impact performance Need to manage separate objects that do belong together, SOP Class future. modeling instead of SOP ( HL7 way), separate info model from communication IHE @ RSNA 2002

  30. Topics in Acquisition/Post-processing domain: Integration, data from multiple modalities needed together, fused, merge recipe. Requires synchronization in time and/or space. US + CathLab PET + CT MR + NM Communication technology Media for exchange, profiles Wireless (TCP/IP is on top of this, should be no issue) IHE @ RSNA 2002

  31. Topics in Archive domain: Delete service. All images come together in central archive with satellites. Co-operation in a loosely connected environment. Co-operation between multiple loosely connected workflow managers. IHE @ RSNA 2002

  32. Topics in Diagnostic Review domain: Presentation, have only grayscale presentation currently. color, 3D, waveform, Cine, MR-multiframe hanging protocols multi-modality presentation SR presentation Interactive collaboration, tele-radiology Data mining, statistics, need for uniform definition. Should we organize a workshop on this topic? IHE @ RSNA 2002

  33. Topics in Reporting domain: Harmonization with CDA L3, XML encoding Next versions of TID 2000, templates Codes, Vocabulary, Procedure Codes, Diagnostic Codes, HIPAA induced codes IHE @ RSNA 2002

  34. Topics in Result Distribution domain: DICOM’s document paradigm: Persistent Object Reference Exchange information outside the DICOM domain HIPAA, Privacy, Security, Authentication, VPN CD/DVD for exchange IHE @ RSNA 2002

  35. Header: Thorax Report Type: ….. ….. ….. Findings: Mass ….. ….. Radiology PACS Daim. Conclusions: Infiltr. ….. ….. (Pointer) Image Refs.: The distribution problem HIS Other Clinical System RIS Cardiology PACS VL, US, NM PACS Electronic Patient Record URL/URI? Webserver Web Viewers IHE @ RSNA 2002

  36. Topics in Treatment/Treatment planning domain: CAD tools, HPGL standard, templates for implants 3D, image guided surgery, contours, locate images in 3D space multi modality aspect Image fusion IHE @ RSNA 2002

  37. Summary of the statements made: We started with the ultimate goal in mind: Quality of Patient Care, Continuity of Care, and the two contributing factors: fast and accurate diagnosis, and most effective treatment plan The key persons to support with information are the technologist, radiologist/cardiologist, and the referring clinician. Images, waveforms, measurement reports are generated and need an integrated presention to the key decision makers. We see this integration and presentation to the diagnostic decision maker as the top priority. Strategic planning process IHE @ RSNA 2002

  38. Statements (continued): We have the feeling that much is available in DICOM which is not deployed in practice to solve integration and presentation problems==> Education and promotion task There will be gaps as well.==> Identify the gaps in the Radiology, Cardiology, NM and US domain Imaging (related) information from other domains (-ologies) needs to be integrated as well==> Convince other -ologies to use the DICOM paradigm for their persistent objects. Strategic planning process IHE @ RSNA 2002

  39. Strategic priorities 4 1 2 3 3 Integration from acquisition via presentation to interpretation and reporting Radiology Acquisition Interpretation Reporting Cardiology Other -ologies Archiving plus Object management Acquisition Interpretation Reporting Ultrasound NM IHE @ RSNA 2002

  40. Scope of DICOM Charter WG10: Strategic Advisory Cmt Trends in Imaging-IT Strategy Planning process Collaboration with other SDOs Overview IHE @ RSNA 2002

  41. 1. Horizontal Integration DICOM 2. Vertical Integration IHE, DICOM, HL7 3. Electronic Patient Record ISO/CEN,DICOM,HL7,XML 4. Orders and Results IHE, DICOM, HL7Management 5. Security IHE,IETF,DICOM,HL7,ASTM 6. Freedom of Application ISO/CEN, CCOW, IETF, Workspot DICOM When new technology is required, the strategy is to adopt proven international, industry or de facto standards. Standards in Imaging-IT IHE @ RSNA 2002

  42. Fostering communication between vendors and users of medical information technology Gaining knowledge of the data required for optimal patient care decisions, i.e. understanding each others problems Driving the deployment and evolution of existing standards Eliminating the gaps and redundancies in data access. IHE - Integrating the Healthcare EnterpriseReducing the Barriers to Optimized Patient Care IHE @ RSNA 2002

  43. Good Type A liaison since April 99. Procedure TC 215 has agreed to rely on DICOM for Medical Imaging Standardization DICOM offers expertise in medical imaging, with world-wide users and vendors representation. Need to ensure coherence with other ISO standards group on imaging related issues (e.g. ISO JTC1 SC9 on JPEG 2000) New workitem: Web Access to DICOM’s Persistent Objects, co-operation of ISO TC 215/WG2 and DICOM in DICOM a WG6 ad-hoc group is established to work on the supplement, together with a group of ISO nominated experts Liaison with TC 215 IHE @ RSNA 2002

  44. WG20: Integration of Imaging and Information Systems, common DICOM-HL7 working group. Works on the harmonization of the information models, HL7 RIM and DICOM Real-World model. Works on the harmonization of DICOM SR and the HL7 CDA (Clinical Document Architecture) level 1,2,3 An informative annex to the DICOM standard will be created with the mapping of DICOM header data element to CDA level 1. CDA level 2 and 3 are progressing. Collaboration with HL7 IHE @ RSNA 2002

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