June 28-29, 2005IHE Interoperability Workshop 1 Integrating the Healthcare Enterprise Cross-enterprise Document Sharing for Imaging (XDS-I) Rita Noumeir.

June 28-29, 2005 IHE Interoperability Workshop1

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

Cross-enterprise Document Sharing for Imaging (XDS-I)

Rita Noumeir Ph.D.

University of Quebec

IHE Technical and Planning Committees


Abstract / ScopeAbstract / 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


Value PropositionValue PropositionImaging 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.


Value PropositionValue PropositionDistributed: 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.


XDS-I DependenciesXDS-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


XDS-I Actors / GroupingXDS-I Actors / GroupingSharing 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


XDS-IXDS-INew TransactionsNew 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


XDS-IXDS-ITransaction DiagramTransaction Diagram

Document Source

Document Consumer

Document Registry

Document Repository

Provide&Register

Document Set[RAD-Y1]

Register Document Set[ITI-14]

Retrieve Document

[ITI-17]

Query Registry [ITI-16]

Patient Identity Source

Patient Identity Feed [ITI-18]

ImageManager/ImageArchive

WADO Retrieve

[RAD-Y6]

Retrieve Images [RAD-16] Retrieve Presentation States [RAD-17] Retrieve Key Image Note [RAD-31] Retrieve Evidence Documents [RAD-45]


XDS-I Required TransactionsXDS-I Required TransactionsDocument 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


XDS-IXDS-IOptionsOptions

Document Source, at least one of the following options Extensive Set of DICOM Instances PDF Report Text Report Multipart Text/PDF Report


Sharing of Sharing of Extensive DICOM Extensive DICOM

Instance SetInstance Set


Document Registry

Document Repository

Manifest

Reference to image 1

DICOM Manifest


Reference to image 3Manifest Manifest

Clinical Encounter

Clinical IT System

Query Registry

Manifest

Retrieve Manifest


DICOM Manifest



Retrieve Images

Register Manifest

Manifest


Extensive DICOM Instance SetExtensive DICOM Instance Set

XDS Document Repository

Image Manager/Archive / Document Source

XDS Document Registry

Provide and Register Document Set

Register Document Set

Query Documents

Retrieve Images

Create Key Object Selection Document

Document Consumer

Decode Key Object Selection Document

Retrieve Document


Sharing of Sharing of Extensive DICOM Extensive DICOM Instance SetInstance 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)


Sharing of Imaging Sharing of Imaging ReportReport


Radiology systemReport Source

…..

Findings:

Header:

Report Type: OB / Gyn

BPD ...…..

Radiology Report

Impressions: GestationalAge

...

Text Report

PDF Report

Text +PDF Report



Document Registry

Document Repository

Report Report

Clinical Encounter

Clinical IT System

Query Registry

Retrieve Report

Register Report

Report

…..

Findings:

Header:


BPD ...…..

Radiology Report

Impressions: GestationalAge

...


Imaging ReportImaging Report

Document Repository

Report Manager / Document Source Document

Registry

Provide and Register Document Set

Register Document Set

Query Documents

Retrieve of referenced Images

Create shared report and include pre-formatted WADO URI to reference relevant images

Document Consumer

Retrieve Report Document

Image Archive


Sharing of Sharing of ReportReportThe 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


Linking Report to Complete Set of ImagesLinking Report to Complete Set of Images

Document RepositoryDocument Repository

Document RegistryDocument Registry

Manifest

Report

DocumentEntry

DocumentEntry

SubmissionSet


Linking Report to Complete Set of ImagesLinking Report to Complete Set of Images



Manifest

DocumentEntry

SubmissionSet 1

Report

DocumentEntry

SubmissionSet 2


Linking Report to Prior Images and Prior Linking Report to Prior Images and Prior ReportReport



Manifest

DocumentEntry

SubmissionSet 3

Prior

Manifest

DocumentEntry

SubmissionSet 1

Prior

Report

DocumentEntry

SubmissionSet 2

Report

DocumentEntry

SubmissionSet 4


Linking Report to Selected Linking Report to Selected ImagesImages


…..

Findings:

Header:


BPD ...…..

Radiology Report

Relevant Image

GestationalAge

...WADO URI

Link to image


XDS-I MetadataXDS-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


More information….More information….

IHE Web site: http://www.ihe.net

http://www.himss.org/IHEhttp://www.rsna.org/IHEhttp://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

Questions?

Questions?

June 28-29, 2005IHE Interoperability Workshop 1 Integrating the Healthcare Enterprise Cross-enterprise Document Sharing for Imaging (XDS-I) Rita Noumeir.

Documents

register document

document consumer slide

document centric

retrieve document iti

imaging xds

transactions document

ihe interoperability

document source rady1