Enterprise-Wide%20Reporting%20And%20The%20Continuity%20Of%20Care:%20The%20Role%20Of%20DICOM%20SR%20And%20HL7%20CDA%20DICOM%20Anniversary%20Conference%20and%20Workshop%202003

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Enterprise-Wide Reporting And The Continuity Of
CareThe Role Of DICOM SR And HL7 CDADICOM
Anniversary Conference and Workshop 2003

• Helmut Koenig, MD (Co-Chair DICOM WG 20)
• Frank Krickhahn (Chair DICOM WG 8)
• Siemens Medical Solutions

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Significance of Reporting

• Radiology and Clinical Reports are the
  End-Products of Diagnostic Processes
• Consolidation of current interpretation results
  that builds on relevant clinical information
• Documents are crucial for cross-boundary,
  interdisciplinary and temporal continuity of
  care in that they convey the essential clinical
  diagnoses and facts
• Health Information Infrastructure Informational
  Continuity of Care

3
Health Information Infrastructure The Reporting
View
4
Standards Achievements

• DICOM
• Recent DICOM SR related supplements
• Supplement 65 - Chest CAD SR
• Supplement 66 - Catheterization Lab SR SOP
  Classes
• Supplement 71 - Vascular Ultrasound SR
• Supplement 72 - Echocardiography Procedure Report
• Supplement 75 - Relevant Patient Information
  Query Service Class
• Supplement 79 - Breast Imaging Report Templates
• Supplement xx - Non-invasive Cardiovascular
  Analysis of CT/MR Procedures
• Workflow Support (Modality and General Purpose
  Worklist SOP Classes)
• Relevant Patient Information Query Service Class
  (Suppl. 75)
• Web Access to DICOM Persistent Objects (WADO)
  (Suppl. 85)

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Standards Achievements

• HL7 / DICOM WG 20 Integration Issues
• Order Entry and Results Reporting Messages
  (Version 2.x and 3)
• Imaging Order Message (Version 2.5)
• Clinical Document Architecture (CDA) Document
  Standard
• Narrative Reports (CDA Release 1)
• Narrative Structured Reports (CDA Release 2)
  will contain imaging specific information

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Current Situation Actions Taken

• Reporting needs pose considerable challenges due
  to the complexity of combining the required
  services and systems integration
• How can this put into place in order to provide
  optimal support for reporting needs?
• Revisit reporting and image interpretation use
  cases / gap analysis
• Discussion started by DICOM WG10 and 20 which
  resulted in use cases which are ordered by
  complexity level

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Hardcopy Image Reading Dictation/Transcription
(Use Case 1)

• Image Reading
• Hardcopy Reading
• Hardcopy DICOM Print as Seen at Modality
• Reporting
• RIS-Based Transcription / Validation of Narrative
  Report
• RIS-Based Report Storage and Management
• Send Reports
• Query Prior Reports

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Hardcopy Image Reading Dictation/Transcription
(Use Case 1)
Report Storage / Mgmt.
Electronic Report
Paper print/ Mail/ Fax/E-mail
send
NarrativeInfo Only
Electronic Report
query
Acquisition
Transcription Correction
print
Validation
Film Archive
Hardcopy Interpretation Dictation
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Hardcopy and Softcopy Image Reading
Dictation/Transcription (Use Case 2)

• Image Reading
• Hardcopy Reading
• Hardcopy DICOM Print as Seen at Modality
• Softcopy Reading
• Hardcopy DICOM Print as Seen During Softcopy
  Reading
• Reporting
• RIS-Based Transcription / Validation of Narrative
  Report
• RIS-Based Report Storage and Management
• Send Reports
• Query Prior Reports

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Hardcopy and Softcopy Image Reading
Dictation/Transcription (Use Case 2)
store
Softcopy Interpretation Dictation
Report Storage / Mgmt.
Electronic Report
Paper print/ Mail/ Fax/E-mail
send
Electronic Report
NarrativeInfo Only
query
Acquisition
Transcription Correction
print
Validation
Film Archive
Hardcopy Interpretation Dictation
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Acquisition Workflow Support Burn CD/DVD (Use
Case 3)

• Image Acquisition
• RIS-based Acquisition Workflow Support (Modality
  Worklist)
• Image Reading
• Hardcopy Reading
• Hardcopy DICOM Print as Seen at Modality
• Softcopy Reading
• Hardcopy DICOM Print as Seen During Softcopy
  Reading
• DICOM Store Images -gt Burn CD/DVD
• Reporting
• RIS-Based Transcription / Validation of Narrative
  Report
• RIS-Based Report Storage and Management
• Send Reports
• Query Prior Reports
• Optional DICOM Store Reports -gt Burn CD/DVD

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Hardcopy and Softcopy Image Reading
Dictation/Transcription (Use Case 3)
Modality Worklist
store
Selected Images
Softcopy Interpretation Dictation
Report Storage / Mgmt.
Electronic Report
Paper print/ Mail/ Fax/E-mail
send
Electronic Report
NarrativeInfo Only
query
Acquisition
Transcription Correction
print
Validation
store
Film Archive
Hardcopy Interpretation Dictation
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PACS for Management of DICOM Persistent Objects
(Use Case 4)

• Image Acquisition
• RIS-based Acquisition Workflow Support (Modality
  Worklist)
• Image Reading
• Hardcopy Reading
• Hardcopy DICOM Print as Seen at Modality
• Softcopy Reading
• Hardcopy DICOM Print as Seen During Softcopy
  Reading
• DICOM Store Images for Burning CD/DVD
• PACS-based Storage and Management of DICOM
  Persistent Objects
• Archive Imaging Studies
• Query Prior Imaging Studies
• Reporting
• RIS-Based Transcription / Validation of Narrative
  Report
• RIS-Based Report Storage and Management
• Send Reports
• Query Prior Reports
• Optional DICOM Store Reports for Burning CD/DVD

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PACS for Management of DICOM Persistent Objects
(Use Case 4)
Modality Worklist
store
Object Storage / Mgmt.
Electronic Report
Electronic Report
Paper print/ Mail/ Fax/E-mail
Selected Images
send
Softcopy Interpretation Dictation
query
NarrativeInfo Only
Transcription Correction
Acquisition
store
Validation
print
store
q/r
Off-Line Archive
store
Burn CD/DVD
Film Archive
Hardcopy Interpretation Dictation
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Basic Integration of Report and Image Information
(Use Case 5)

• Additions
• Image Reading
• DICOM Store Images for Burning CD/DVD
• Selection of Evidence Objects (I.e. Images) and
  Associated Presentation States
• Reporting
• RIS-Based Report Storage and Management
• Send Reports
• Query Prior Reports
• DICOM Store Reports for Burning CD/DVD
• Relate Evidence Objects to Report by Reference
• Note Hardcopy Reading Skipped for Brevity

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Basic Integration of Report and Image Information
(Use Case 5)
Modality Worklist
store
Object Storage / Mgmt.
Electronic Report
Electronic Report
Paper print/ Mail/ Fax/E-mail
send
Softcopy Interpretation Dictation
query
Inclusion of References to Selected Objects
(I.e. Images)
Transcription Correction
NarrativeInfo Only
Acquisition
Images Presentation States Key Image Notes
store
Validation
store
q/r
Off-Line Archive
store
Evidence Documents Imaging Reports
Burn CD/DVD
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Access to Relevant Information (Use Case 6)

• Additions
• Access to Relevant Information
• RIS/PACS-based Storage and Management of DICOM
  Persistent Objects
• Interfaces/Gateway for Imaging Information
  Queries
• Export Imaging Results/Evidence to EHR
  (Electronic Health Record)
• EHR-Based Management of Patient Clinical History
  Information
• Interfaces/Gateway for EHR Relevant Patient
  Information Queries
• Note Hardcopy Reading Burn CD/DVD Skipped for
  Brevity

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Access to Relevant Information(Use Case 6)
Gateway
Relevant Patient Information Query
HL7 Interface
DICOM SR Text DICOM Images
export
store
HL7 CDA Rel. 1 JPEG Images
Modality Worklist
store
Web Interface
Object Storage / Mgmt.
Electronic Report
send
Softcopy Interpretation Dictation
query
WADO
Web Interface
Transcription Correction
NarrativeInfo Only
WADO
Acquisition
DICOM Interface
Web Gateway
Images Presentation States Key Image Notes
Validation
store
q/r
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Postprocessing Workflow Structured Reporting
Based on Evidence Documents (Use Case 7)

• Additions
• Postprocessing
• Postprocessing Workflow Support (Postprocessing
  Worklist)
• Creation of Evidence Documents Results
• Reporting
• RIS-Based Report Storage and Management
• Support for Transcription Worklist
• Support for Interpretation Worklist
• Access to Relevant Information
• RIS/PACS-based Storage and Management of DICOM
  Persistent Objects
• Interfaces/Gateway for Imaging Information
  Queries
• Export Imaging Results/Evidence to EHR
• EHR-Based Management of Patient Clinical History
  Information
• Interfaces/Gateway for EHR Relevant Patient
  Information Queries
• Note Hardcopy Reading Burn CD/DVD Skipped for
  Brevity

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Postprocessing Workflow Structured Reporting
Based on Evidence Documents (Use Case 7)
Gateway
Relevant Patient Information Query
HL7 Interface
Modality Worklist
export
Interpretation / Sign-Off Worklist
store
HL7 CDA Rel. 1 JPEG Images
DICOM SR Text DICOM Images
Transcription Worklist
store
Web Interface
NarrativeInfo Only
Object Storage / Mgmt.
Electronic Report
send
Extract Measurements Add Codes Interpretation
Validation
query
WADO
Post-Processing Worklist
Transcription Correction
Web Interface
WADO
Images Evidence Documents /Validated
ED Presentation States Key Image Notes SR with
References - Images, PS, KIN, ED
Acquisition
DICOM Interface
Web Gateway
Images Evidence Documents Presentation States
store
Images Evidence Documents Presentation States
q/r
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Terminology Service Export of Structured
Documents (Use Case 8)

• Additions
• Reporting
• RIS-Based Report Storage and Management
• Support for Dictation Worklist (Voice Recognition
  / NLP Substitutes Transcription)
• Access to Relevant Information
• RIS/PACS-based Storage and Management of DICOM
  Persistent Objects
• Export Structured Documents to EHR (Rather than
  Narrative Report)
• Note Hardcopy Reading Burn CD/DVD Skipped for
  Brevity

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Terminology Service Export of Structured
Documents (Use Case 8)
Terminology Service
Coding Scheme Repository
Gateway
Relevant Patient Information Query
HL7 Interface
Modality Worklist
export
Interpretation / Sign-Off Worklist
store
HL7 CDA Rel. 2 JPEG Images
Voice Recognition / Natural Language Processing
DICOM SR DICOM Images
store
Web Interface
Object Storage / Mgmt.
Dictation Worklist
Extract Measurements Add Codes Interpretation, Co
rrection Validation
WADO
Post-Processing Worklist
Web Interface
WADO
Images Evidence Documents /Validated
ED Presentation States Key Image Notes SR with
References - Images, PS, KIN, ED
Acquisition
DICOM Interface
Web Gateway
Images Evidence Documents Presentation States
store
Images Evidence Documents Presentation States
q/r
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Conclusions

• Use cases 1-4 are well understood and covered by
  DICOM
• Use case 5 Basic Integration of Report and
  Image Information
• Selection of Evidence Objects and Associated
  Presentation States at the Interpretation
  Workplace
• Inclusion of these selected references into
  narrative report and provision of the integrated
  information...
• Could be the next step we should focus on and
  fill potential gaps

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Questions

• Do the scenarios meet your needs?
• Is there anything missing?

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Back-up Slides
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Significance of Reporting

• Radiology and Clinical Reports are the
  End-Products of Diagnostic Processes
• Consolidation of current interpretation results
  that builds on relevant clinical information
• Turnaround time and quality are critical factors
  for clinicians satisfaction
• Report is the legally authenticated document (by
  electronic means or on paper) of the accountable
  physician
• Documents are crucial for cross-boundary,
  interdisciplinary and temporal continuity of
  care in that they convey the essential clinical
  diagnoses and facts
• Use of DICOM and standards like HL7 for ensuring
  the informational continuity of care in the scope
  of
• Departmental (i.e. Imaging) and Hospital
  Information Systems, Electronic Health Record
  (EHR)
• Health Information Infrastructure
  (Hospital/Primary Care, Personal Health
  Management, Public Health)

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Critical Factors for Reporting Continuity of
Information Perspective

• Ease of access and availability of relevant
  information
• Study Context Current prior imaging studies
  and reports
• Patient Context Access to relevant clinical
  information (Procedure and indication based)
• Limitations primarily due to use of hardcopy
  images and paper reports
• Completeness, diagnostic accuracy and ease of
  referencing evidence objects
• Dictation/Transcription vs. Structured Reporting
• Potential limitations due to use of narrative
  reports instead of template-based structured
  reports which include references to evidence
  objects
• Workflow Support
• HL7 Order Entry and Results Reporting Messages
• DICOM Modality Worklist and General Purpose
  Worklist
• Semantic Interoperability
• Reference Terminology (Semantic Backbone)