Post on 27-Mar-2015
Sept 13-15, 2004 IHE Interoperability Workshop1
Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise
Key Image Notes
Simple Image & Numeric Report
Evidence DocumentsSanjay Jain
Co-Chair, Radiology Planning Committee
Sept 13-15, 2004 IHE Interoperability Workshop2
Value PropositionValue Proposition
Share diagnosis, reports and images
Standard mechanism to communicate with the referring physicians
Enable Automated handling based on coded data E.g. Routing Mammo Follow-up and checking Clinical trials
Avoid dependence only on memory
Paper, audio ..
Data mining
Sept 13-15, 2004 IHE Interoperability Workshop3
Don’t Call Us, We’ll Call YouDon’t Call Us, We’ll Call You
“Dave, you read that 3000 slice MR study last night. Can you highlight the 5 most important images for me” Thinking… “#$@%!%# You”, says “Sure”
“Dr. Channin, I just reviewed 40 cases and marked my questions on yellow stickies. Can you review those”
Tech to radiologist: “The patient wouldn’t hold still”
The solution is……The solution is……
Sept 13-15, 2004 IHE Interoperability Workshop4
IHE Radiology Integration ProfilesIHE Radiology Integration Profiles
Patient Info.
Recon-ciliation
Access to Radiology Information
Consistent Present-ation of Images
Basic Security
-
EvidenceDocs
Simple Image & Numeric Reports
Presentation of Grouped Procedures
Post-
Processing Workflow
Reporting Workflow
Charge Posting
Scheduled Workflow
Portable Data for Imaging
NMImage
KeyImageNotes
Sept 13-15, 2004 IHE Interoperability Workshop5
for referring physicianHere you can see the renal osteopathy.
For teachingFibroosteoclasia
Sept 13-15, 2004 IHE Interoperability Workshop6
Different notes on different images
Same note on different images
for referring physicianHere you can see the renal rupture.
Note1for referring physicianThis is the hematoma.
Note2
for refering physicianHere you can see the renal rupture.
Note1for refering physicianThis is the hematoma.
Note2
for refering physicianHematoma everywhere
Note3 for refering physicianHematoma everywhere
Note3for refering physicianHematoma everywhere
Note3 for refering physicianHematoma everywhere
Note3
for referring physicianHematoma everywhere
Note3
Sept 13-15, 2004 IHE Interoperability Workshop7
Key Image Notes Titles are CodedKey Image Notes Titles are CodedDefined by DICOM Supplement 59. May be extended
The note title defines the semantics The note title defines the semantics of the reason of significance.of the reason of significance.
Key Image Notes cKey Image Notes can be queried by an be queried by code.code.
The user comments are meant to be The user comments are meant to be informalinformal..
CodesOf Interest
Rejected for Quality Reasons
For Referring Provider
For Surgery
For Teaching
For Conference
For Therapy
For Patient
For Peer Review
For Research
Quality Issue
Reporting (CP in ballot)
Sept 13-15, 2004 IHE Interoperability Workshop8
Key Image NotesKey Image NotesThere is more to teamwork than images and reports
With IHE, it is possible to attach « electronic post-it™ » to images to increase informal but critical communication between:
The Technologist and the Radiologist about specific examination events
The Radiologist and the Technologist about image quality issues
The Radiologist and other department clinicians (surgeon, orthopedist,..)
The Radiologist and collegues about selecting images for conferences
The Radiologist to the Referring Provider, …..etc.
Query for the Images/Studies using the codes
This IHE Integration Profile is the cost effective solution (increases radiology and overall efficiency)
Sept 13-15, 2004 IHE Interoperability Workshop9
Evidence DocumentsEvidence Documents
…..
Findings:
Image Refs.:
Header:
Report Type: OB / Gyn
BPD...…..
Evidence Document Evidence Document StoredStored
Storage CommitmentStorage Commitment
Query / RetrieveQuery / Retrieve
Sept 13-15, 2004 IHE Interoperability Workshop10
Evidence DocumentsEvidence Documents
Measurements and coded data DICOM SR document
Created by either Acquisition Modality or Evidence Creator
Produced during acquisition or post-processing workflows
Interpreted along with the images
Sept 13-15, 2004 IHE Interoperability Workshop11
Evidence Documents Evidence Documents ExamplesExamples
Mammography CAD
Chest CAD
OB-Gyn Ultrasound Measurements
Vascular Ultrasound Measurements
Vascular Intervention Results
Echocardiography Measurements
Sept 13-15, 2004 IHE Interoperability Workshop12
Interpretation
…..
Findings:
Image Refs.:
Header:
Report Type: OB / Gyn
BPD ...…..
Simple Image & Simple Image & Numeric ReportNumeric Report
Evidence Evidence DocumentsDocuments
…..
Findings:
Image Refs.:
Header:
Report Type: OB / Gyn
BPD ...…..
Radiology Report
Impressions: GestationalAge
...
Key Image NotesKey Image Notes
Sept 13-15, 2004 IHE Interoperability Workshop13
Can You Make A Report Like This?Can You Make A Report Like This?Institution IdentificationPatient IdentificationStudy Identification
Technique Identification
Discussion
The liver is normal. There is a focal area of decreased attenuation adjacent to the falciform ligt., likely representing focal fat (image 22). The spleen, both kidneys, the … are normal.
Impression
CT of the abdomen within normal limits
Signature
The solution is……The solution is……
Sept 13-15, 2004 IHE Interoperability Workshop14
(We can’t either). What about?(We can’t either). What about?
Discussion
Comparison is made to the prior study of 4/11/99. The left paratracheal lymph node (image 8, image 11) now measures 2.5x2.7x3.1 cm increasing from 2.0x2.1x2.6 previously. No other mediastinal, upper abdominal or axillary adenopathy is identified. No focal pulmonary lesions are seen. The yadda, yadda, yadda are normal.
Impression
Worsening L Paratracheal adenopathy.
Signature
Sept 13-15, 2004 IHE Interoperability Workshop15
IHE Radiology Integration ProfilesIHE Radiology Integration Profiles
Patient Info.
Recon-ciliation
Access to Radiology Information
Consistent Present-ation of Images
Basic Security
-
EvidenceDocs
KeyImageNotes
Presentation of Grouped Procedures
Post-
Processing Workflow
Reporting Workflow
Charge Posting
Scheduled Workflow
Portable Data for Imaging
NMImage
Simple Image & Numeric Reports
Sept 13-15, 2004 IHE Interoperability Workshop16
Simple ImageSimple Imageandand
Numeric ReportsNumeric Reports
Sept 13-15, 2004 IHE Interoperability Workshop17
Simple ImageSimple Image& Numeric& Numeric
ReportsReports
• Based on DICOM SRBased on DICOM SR
• Allows to include Allows to include without transcription:without transcription:- measurements- measurements- image links- image links- structured content - structured content
• Integrated with the Integrated with the imaging workflowimaging workflow
• Friendly to XML Friendly to XML implementationsimplementations
• Easy to export to the Easy to export to the EPR (HL7)EPR (HL7)
Sept 13-15, 2004 IHE Interoperability Workshop18
Pattern – Pattern – Simple Image ReportSimple Image Report
• Minimal Structure : Coded Title and HeadingsMinimal Structure : Coded Title and Headings• Full image links from specific sections of reportFull image links from specific sections of report• Observation Context Observation Context (who, what, when)(who, what, when) may be section specific may be section specific
0-n
CONTAINS 1
CONTAINS
0-n
0-n
INFERRED FROM
Report Text
Image Reference
Observation Context
(See section 5.3.2.3) 1-n
Section Heading
Document Title
Image Reference
0-1
Observation Context
(See section 5.3.2.3)
0-n
Coded Entry
0-n
INFERRED FROM
Image Reference
Sept 13-15, 2004 IHE Interoperability Workshop19
Pattern – Pattern – Simple Image & Simple Image & Numeric ReportNumeric Report
Simply adds Measurements to Simple Image ReportsSimply adds Measurements to Simple Image Reports
0-n
CONTAINS
HAS OBS CONTEXT
1
CONTAINS
0-n
Report Text
Image Reference
Observation Context
(See section 5.3.2.3) 1-n
Section Heading
Document Title
HAS OBS CONTEXT
0-1
Observation Context
(See section 5.3.2.3)
0-n
Coded Entry
0-n
0-n
INFERRED FROM
Image Reference
Measurement
0-n
Measurement
0-n
INFERRED FROM
Image Reference
Measurement
0-n
Sept 13-15, 2004 IHE Interoperability Workshop20
An IllustrationAn Illustration Chest, PA & Lateral Chest, PA & Lateral (GCS,T78) (GCS,T78)
ProcedureProcedure
PA and Lateral radiographs were …….PA and Lateral radiographs were …….
ConclusionsConclusionsPossible Mass Possible Mass (ICD,XXX)(ICD,XXX)
FindingsFindings
The PA demonstrates ... A small opacity The PA demonstrates ... A small opacity is visible in the base of lung in lateral is visible in the base of lung in lateral view. Image 32 view. Image 32
CT recommended.CT recommended.
Dr Andrew SmithDr Andrew Smith……. ……. George JonesGeorge Jones
…...…...
Sept 13-15, 2004 IHE Interoperability Workshop21
Simple Image and Numeric ReportSimple Image and Numeric Report
Reports’ content is more than words…..
SINR is the Output of Interpretation, while Evidence documents are Input for Interpretation
With IHE, it is possible to add value to reports/preliminary reports by organizing content
This IHE Integration Profile is the cost effective solution to sharing reports and enabling content processing applications (increases radiology efficiency)
Sept 13-15, 2004 IHE Interoperability Workshop22
More information….More information….IHE Web sites:
http://www.himss.org/IHEhttp://www.rsna.org/IHEhttp://www.acc.org/quality/ihe.htm.
Technical Frameworks:• ITI V1.0, RAD V5.5, LAB V1.0
Technical Framework Supplements - Trial Implementation• May 2004: Radiology• August 2004: Cardiology, IT Infrastructure
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
Questions?
Questions?