Standards for Image & Report Sharing for Tele-radiology & EPR - update on Canada Infoway & US HIE Peter Bak, Ph.D., CMC EHI Live 2012 May 2012

Transcription

1 Standards for Image & Report Sharing for Tele-radiology & EPR - update on Canada Infoway & US HIE Peter Bak, Ph.D., CMC EHI Live 2012 May 2012

2 Disclosures Consultant to: Humber River Regional Hospital McKenzie Health Peel Memorial Health Centre PHSA British Columbia Hospital Diagnostic Imaging Repository Services (HDIRS) Advisor to: Laboratory for Medical Imaging Informatics, Shanghai Institute of Technical Physics 2

3 6 November 2012 Set some context! 3

4 6 November 2012 Radiologist Office w/ RIS/ Teleradiology Requirements Send new studies out to be read by a Radiologist at a remote location Send to a specific Radiologist Send to a group RIS/ Radiologist Office w/o 4

5 6 November 2012 Radiologist Office w/ RIS/ Teleradiology Functional Requirements Send report back to location that sent the study and to the system that distributes it to referring physicians RIS/ Radiologist Office w/o 5

6 6 November 2012 Radiologist Office w/ RIS/ Teleradiology Challenges RIS/ Radiologist Office w/o 1. If I am at the office then I want the study to come in to my so that I can read it as part of my daily workflow 2. I want relevant priors to be automatically available to me! 3. I want to be assured I have the latest version 4. I want the report to automatically go back to the RIS for the site where the study came from 6

7 6 November 2012 Radiologist Office w/ RIS/ EHR Functional Requirements Publish imaging exams (studies and reports) for consumption by those that need them = circle of care (CoC) members RIS/ Radiologist Office w/o 7

8 6 November 2012 Ambulatory EMR RIS/ EHR Functional Requirements CoC members access the exam results from anywhere and at anytime Using a portal application From within an EMR (acute centre, ambulatory clinic, GP office) From a viewing client Acute Centre EMR Portal 8

9 6 November 2012 Ambulatory EMR EHR Challenges Publisher I want to publish the exams and assume that only CoC members will be allowed to access them I don t want to spend energy putting locks on the exam result I want to publish changes that I make to the results Consumer I want to be able to search for the results using Acute RIS/ Centre patient credentials and exam credentials EMR I want to be able to view the results in my application Portal 9

10 Technical Components that need to be Standardized Communication mechanisms/protocols Data format Patient Identification* Exam description (Terminology) Change controls mechanisms Access control* Method for ingestion of data into systems (Foreign Exam Management) * Not covered in this presentation 10

11 6 November 2012 Canadian Standards Update 11

12 6 November 2012 Pan-Canadian DI Repositories (DI-r) 12

13 6 November 2012 Pan-Canadian DI Repositories (DI-r) 13

14 Standards Progress Standards Collaborative Working Group 10 (SCWG 10) is focused on DI Members are from across Canada Work is driven by the practical experiences gained from implementing the pan-canadian DI Repositories 14

15 Communication Protocols Images à DI-r DICOM DI-r publishes to XDS Repository/Registry XDS-I.b EHR portals consume using XDS-I.b XDS-I.b/WADO DI-r à (local) DICOM DI-r à (foreign) WADO DI-r à Viewing clients WADO/JPEG Reports RIS à DI-r HL7 v2.x DI-r publishes to XDS Repository/Registry XDS-I.b EHR portals consume using XDS-I.b XDS-I.b DI-r à (local) Proprietary DI-r à DI-r XDS-I.b 15

16 Communication Protocols SCWG 10 is soliciting IHE to adopt extensions of the Registry Accession # Remove any ambiguity related to linking a report(s) with its associated manifest(s). Study Instance UID Facilitate manifest updates when a study content changes without the need for an updating system to keep track of manifest unique Id in its proprietary database Complete Image Set Designator A code designating whether the manifest encompasses key instances only or all instances Study Description Just easier than using the Document Title attribute! 16 Referring Physician Keep track in XDS of who requested a particular exam

17 Implementation Most image sharing is between Acute centres à DI-r using DICOM DI-r à Viewers (proprietary streaming) Reports are sent to and DI-r using HL7 2.x Consuming achieved through DICOM viewers directly from the DI-r 3 projects have deployed XDS-I.b Alberta, Ontario and Quebec 17

18 Data Format Images are DICOM Reports: Proposed standard for EHR scenario is CDA R2 For the teleradiology scenario, CDA R2 presents challenges DI-rs maintain reports as text blobs in the database or as DICOM SR objects When reports are shared between, it is easier to share DICOM objects as opposed to CDA R2 documents Implementation Nobody is using CDA R2 yet Reports are maintained as text blobs 18

19 Exam Description (Terminology) Adopting SNOMED-CT specifically for: DI procedures Modalities Body part Laterality Motivation for standardizing: Clinicians will be searching for exams for a specific patient Clinicians would like to see their patient s exams with like exams from different organizations displaying the same procedure description Clinicians may not know the modality code for a procedure Clinicians would like to know the laterality of certain body parts Systems wish to retrieve relevant priors 19 Implementation A few DI-rs have standardized their procedure set based on NHS

20 Change Control SCWG 10 is driving a new IHE profile: Image Object Change Management (IOCM) Purpose is to support communication of change: à DI-r DI-r à XDS-I.b domain Typical changes include: Correction/update of demographics Splitting/combining studies Updating references to other related instances Taking bad images out of circulation Implementation Manual! 20

21 Foreign Exam Management FEM is about automatically ingesting foreign exam results in to a so that users can consume the results in the context of local workflow (and systems) FEM is critical to support the Teleradiology use case Implementation FEM is deployed at HDIRS (using DICOM) Agfa à GE Agfa à Sectra McMaster will deploy using XDS-I.b 21

22 6 November 2012 US Standards Update 22

23 Meaningful Use and ONCHIT Driver #1: Imaging results and information are accessible through Certified EHR Technology Driver #2: Require EHR technology to be capable of enabling images formatted according to DICOM standard to be downloaded and transmitted to a third party 23

24 Technical Standards ONCHIT does not drive a specific standard in the same way that Canada does! DICOM image format is firm but not much else: Reports do not need to be structured There is no recommendation for transport mechanisms There is no clarity on how images or image pointers are discovered and/or communicated to EHR Technologies 24

25 In Practice (Teleradiology) Private Teleradiology networks Use DICOM to transport images Reports are pushed back to RIS via , HL7, PDF, fax Leverage proprietary application layers to route and manage worklists Standards: DICOM HL7 v2.x 25

26 In Practice (EHR) RSNA Image Share Project Leverages XDS-I.b to support download and transmit to a third party Will be extended to integrate multiple XDS domains through XCA Add provider to provider workflow Standards: DICOM XDS-I.b HL7 v2.x Reports are in plain text 26

27 In Practice (EHR) Vendor Neutral Archives (VNA) HIEs use VNAs as a central repository Leverage a common viewer to access the images Integrated with EMR applications Standards DICOM HL7 v2.x DICOM SR (?) Reports (?) 27

28 28 Where would I place my bet? XDS-I.b (or maybe XDR-I.b) Vendors are adopting Projects around the world are implementing WADO Any transfer of image data over WAN should use Internet protocols (and not DICOM) XDS-I.b supports RAD-55 = WADO RAD-69 = images using SOAP and MTOM with XOP Formats DICOM for images CDA R2 for reports, but you still need to support until they become XDS document consumers DICOM wrapped text or PDF DICOM SR but not many can render DICOM SR (yet) EMRs do not support CDA R2, so stick with HL7 v2.x messages

29 Where would I place my bet? Terminology Live without it for now until somebody has done a real implementation of SNOMED-CT terminology normalization Change Control Manual for now but push IHE to address this! FEM Deploy proxy servers they work well and the benefit is significant! vendors will get there eventually! 29

30 Thank You!