State of the Standards 2018 Focus on Access to Imaging Content - PowerPoint PPT Presentation

State of the Standards 2018 Focus on Access to Imaging Content Kinson Ho, Solution Architect Change Healthcare IHE Radiology Technical Committee Co-Chair

We build bridges to connect information islands

Import and Display of External Priors (IDEP) Motivation • Commonly priors are located outside the reading institution • Cannot reliably locate, access, and view priors during the short time frame required to be relevant to reading – DVDs, web portals are inadequate – Prior radiology reports are rarely accessible – Prior images, if available, cannot be presented for side-by side comparison using local hanging protocols • Patients may need to be re-imaged (radiation, cost, and time) * Courtesy Teri Sippel, Vital Images

IDEP Imaging Study Flow * Courtesy Teri Sippel, Vital Images

IDEP Report Flow * Courtesy Teri Sippel, Vital Images

Connected Digital Health Ecosystem

Moving from Service Design to Ecosystem Thinking

Problems to Solve in Imaging Image sharing & Secure web access Interactive Ease of integration to imaging studies viewing Neutral to image sharing infrastructure: DICOM, XDS-I, MHD

DICOMweb x HL7 FHIR

What is HL7 FHIR? • F ast <Pa t i e nt xm l ns =" ht t p: / / hl 7. or g/ f hi r " > <i d va l ue =" 31415" / > – Focus on design and <i de nt i f i e r > <us e va l ue =" us ua l " / > implementation efficiency <l a be l va l ue =" M RN" / > <s ys t e m va l ue =" ht t p: / / www. goodhe a l t h. or g/ i ds / m r s " / > • H ealthcare <va l ue va l ue =" 123456" / > </ i de nt i f i e r > – Don’t try to cover other domains <na m e > <f a m i l y va l ue =" Le vi n" / > <gi ve n va l ue =" He nr y" / > • I nteroperable </ na m e > <ge nde r va l ue =" m a l e " / > – Systems should just work together <bi r t hDa t e va l ue =" 1932- 09- 24" / > <c a r e Pr ovi de r > <r e f e r e nc e va l ue =" Or ga ni z a t i on/ 2" / > • R esources <di s pl a y va l ue =" Good He a l t h Cl i ni c " / > </ c a r e Pr ovi de r > – Fundamental building blocks <a c t i ve va l ue =" t r ue " / > </ Pa t i e nt > * Courtesy Elliot Silver, Change Healthcare

Mobile Access to Health Document (MHD) Document Document Source Consumer  Provide Document  Find Document Manifest  Find Document References Bundle  Retrieve Document Document Document Responder Recipient

MHD: XDS on FHIR Option

MHD x IDEP = Remote HL7 Report Access • For remote HL7 report access – Define a Report Access Gateway – Use MHD as the interface for Query and Retrieve of reports – Output continues to use HL7 ORU  MHD Tx  HL7 ORU Remote Report Access Local Report Source Importer Gateway Report Manager (e.g. EMR)

DICOMweb Overview • Suite of RESTful DICOM protocols DICOMweb DIMSE Service Description Equivalent • Recent work: WADO-RS Retrieve instances or C-MOVE, frames C-GET – Non-patient instances ● • Non-rendered – Redocumentation ◐ • Rendered (e.g., JPG) • Metadata, – Retrieve thumbnail ● • Bulk (pixel) data QIDO-RS Query C-FIND • Patient, study, series, instance • Original WADO-URI still supported STOW-RS Upload instances C-STORE UPS-RS Workflow tracking MWL, MPPS * Courtesy Elliot Silver, Change Healthcare

Web-based Image Capture (WIC) Value Proposition A simple, lightweight, mobile-friendly mechanism to encode and send DICOM encapsulated images, videos and evidence documents from the mobile device to the Image Manager so that these objects can be easily integrated into the rest of the imaging workflow

WIC Technical Highlights • Capture Patient and Study Context • Implicit (e.g. with the integrated viewer, EMR, etc.) in case of the Append Case • Explicit (via IHE ITI PDQm, QR code, bar code, manual Image Capturer entry, etc.) • Uses DICOMweb™ for content and transport  Store Instances • Content can be created using DICOM binary, XML or JSON over the web • Client is responsible for including all proper contents Imaging • Use STOW-RS for transport Document Responder • Image Manager • Converts received objects into DICOM binary instances

Web-based Image Access (WIA) Value Proposition Methods for image sharing and interactive viewing of imaging studies using RESTful services such as  WADO-RS and QIDO-RS.

WIA Technical Highlights • Neutral about backend image sharing infrastructure Imaging – XDS / XDS-I Document Consumer – DICOM / DICOMweb QIDO-RS   WADO-RS Query Retrieve • Integrates with ITI MHD Imaging Imaging Document Document – Document Consumer can locate and interact Responder Source with imaging studies more efficiently using document metadata

Recent Enhancements to XDS-I • Imaging Document Source has a new Reference ID option – CP-RAD-352 – Required to provide Accession Number and Study Instance UID in ReferencedIdList • Imaging Document Source has a new Delete Imaging Document Option – CP-RAD-320 – Grouped with ITI Remove Metadata and Document (RMD) Document Administrator actor – Delete manifest or report from Document Registry and Repository

Participate • Great opportunity to learn • Great opportunity to contribute • All three communities are open to new members/contributors – Application process – Patent policy