Review and update of IHE

1. Review and update of IHE The Future & XDS–I

2. Overview - IHE Updates • IHE Organisational Changes • The Infrastructure Domain • Radiology Update • XDS-I

3. IHE Political Update • IHE has moved on from Radiology • Cardiology • Laboratory • Patient Care Coordination • (Vetinary) • Moved on from US-centric • Established Regional and National Committees

4. Current IHE Domains • IT Infrastructure • Radiology • Cardiology • Laboratory • Nuclear Medicine

5. Profiles of Interest - ITI • Established: • Patient Synchronized Applications (PSA) • Patient Identifier Cross-referencing (PIX) • Patient Demographics Query (PDQ) • Personnel White Pages (PWP) • Audit Trail and Node Authentication (ATNA) • Enterprise User Authentication (EUA) • Retrieve Information for Display (RID) • Cross-Enterprise Document Sharing (XDS) • Trial: • Document Digital Signature (DSG) • Notification of Document Availability (NAV) • Development: • Cross-enterprise User Authentication (XUA)

6. New Profiles of Interest - Radiology • Established: • Reporting Workflow (RWF) • Portable Data for Imaging (PDI) • Post-Processing Workflow (PWF) • Trial: • Cross-enterprise Document Sharing for Imaging (XDS-I) • Teaching File and Clinical Trial Export (TCE) • Radiology Audit Trail Option • Development: • Import Reconciliation Workflow (IRWF) • Image Fusion (FUS) • Mammography Image (MAMMO)

7. Current Intra-Trust/Cluster Image Sharing Problems • DICOM C-MOVE problems • Network Addressing Issues • Unknown Recipients • Indexing • Which trusts hold data for a patient? • Updating • Error correction and cascading • Multi-site studies • Where is “home” for the study ? • Lack of agreement between Vendors on how to go forward • How to bolt security onto DICOM

8. The IHE XDS Profile • “Generic” means of sharing clinical documents • Part of ITI domain (not Radiology) • Based on clinical and non-clinical standards: • Transmission: http/https • Indexing: ebXML • Documents: CDA v2 PDF etc.

9. XDS Concepts • Actors • Document Source • Document Repository • Document Registry • Document Consumer • Other concepts • “Submission Set”

10. Meta-Data Only Full Document XDS Overview Identity Source DocumentRegistry User Document Source Document Repository

11. XDS-I • Like XDS but based on: • DICOM (data format) • WADO or native DICOM (retrieval mechanisms) • Uses the same registry • A submission set is a DICOM Key Object Note (manifest) object • May include representative sub-sets • Use of WADO permits retrieval either as JPEGs for simpler browsers or full DICOM images • Compatible with caching but still with integrity

12. Meta-Data Only Full Images Selected Manifest XDS-I Overview Identity Source ImageRegistry User Image Source Image Repository

13. Problems solved by XDS-I • Use of WADO for retrieval solves C-MOVE problems • One registry solves indexing problems • There is an explicit mechanism to update/delete registrations (no equivalent in DICOM) • “Submission Sets” are independent of StudyUID, so mixtures from different trusts are not a problem • New but increasingly supported international standard (being implemented in Canada and many others) • Uses Standard web security mechanisms • Standardised access allows “web access” to be used for pre-fetching etc., and integration with other clinical data

14. Conclusions • Virtually all the problems being worked on by CfH have already got agreed international IHE solutions which are supported by vendors • XDS & XDS-I in particular provide a mechanism to provide wide-area area, but fully controlled access to medical data, with proper specialisation for images • The Connectathon next week should be interesting!