Integrating the Healthcare Enterprise

February 8, 2005 IHE Europe Educational Event1

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

Key Image Notes

Simple Image & Numeric Report

Evidence DocumentsSanjay Jain

Co-Chair, Radiology Planning Committee


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


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……


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


for referring physicianHere you can see the renal osteopathy.

For teachingFibroosteoclasia


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


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)


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)


Evidence DocumentsEvidence Documents

…..

Findings:

Image Refs.:

Header:

Report Type: OB / Gyn

BPD...…..

Evidence Document Evidence Document StoredStored

Storage CommitmentStorage Commitment

Query / RetrieveQuery / Retrieve


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


Evidence Documents Evidence Documents ExamplesExamples

Mammography CAD

Chest CAD

OB-Gyn Ultrasound Measurements

Vascular Ultrasound Measurements

Vascular Intervention Results

Echocardiography Measurements


Interpretation

…..

Findings:

Image Refs.:

Header:


BPD ...…..

Simple Image & Simple Image & Numeric ReportNumeric Report

Evidence Evidence DocumentsDocuments

…..

Findings:

Image Refs.:

Header:


BPD ...…..

Radiology Report

Impressions: GestationalAge

...

Key Image NotesKey Image Notes


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……


(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


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


Simple ImageSimple Imageandand

Numeric ReportsNumeric Reports


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)


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


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


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

…...…...


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)


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?

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