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RSNA 2005 – infoRAD
Defining Clear and Complementary Roles for
HL7 CDA (Clinical Document Architecture)
and DICOM SR (Structured Reporting)
in Diagnostic Reporting
Fred M. Behlen, PhDAmerican College of Radiology
Co-Chair, DICOM Working Group 20 & HL7 Imaging Integration SIG
Co-Chair, HL7 Structured Document TC
President, LAI Technology, Homewood, IL
Harry SolomonGE Healthcare
Co-Chair, DICOM Working Group 1
Co-Chair, IHE Cardiology Technical Committee
2
Disclosure• Fred Behlen
– Employee, LAI Technology (Laboratory Automation Inc.)
• Shareholder, Director, Officer• Partner, Migratek Data Migration Services• Consultant, XStor Medical Systems
• Harry Solomon– Employee, GE Healthcare
3
Acknowledgements• Bob Dolin, Liora Alschuler, Calvin Beebe – co-
chairs of HL7 Structured Documents Technical Committee, and authors of presentations on CDA used in this talk
• Dave Clunie – former co-chair of DICOM Standards Committee, and author of the definitive book on DICOM Structured Reporting
4
Objectives• Understand the HL7 CDA (Clinical Document
Architecture) and its use cases• Understand DICOM SR (Structured Reporting)
and its use cases, including Key Image Notes, Evidence Documents and CAD (Computer Aided Diagnosis) results
• Understand the workflows for reporting, and the appropriate places for DICOM SR and HL7 CDA in those workflows
• See example implementation scenarios
5
HL7 Clinical Document
ArchitectureOverview
6
HL7 Clinical Document
Architecture• The scope of the CDA is the standardization of clinical documents for exchange.
• A clinical document is a documentation of observations and other services with the following characteristics:– Persistence– Stewardship– Potential for authentication– Wholeness– Human readability
• A CDA document is a defined and complete information object that can exist outside of a message, and can include text, images, sounds, and other multimedia content.
7
CDA History• 1996 – initial discussions
• 1997 – HL7 SGML SIG– Use of Standard Generalized Markup Language for adding metadata to
documents– Later evolved to Extensible Markup Language (XML) subset of SGML– Kona Editorial Group
• 1998 – Patient Record Architecture draft• 2000 – Clinical Document Architecture Release 1 adopted
– Limited to “level 1”• 2000 – SIG becomes HL7 Structured Documents Technical
Committee• 2005 – Clinical Document Architecture Release 2 adopted
– Expanded to “levels 2 & 3”
8
CDA Use Cases• Diagnostic and therapeutic procedure
reports
• Encounter / discharge summaries
• Patient history & physical
• Referrals / prescriptions
• Uniform format for all clinical documents
9
Key Aspects of the CDA• CDA documents are encoded in Extensible Markup
Language (XML)• CDA documents derive their meaning from the HL7
Reference Information Model (RIM ) and use HL7 V3 data types
• A CDA document consists of a header and a body– Header is consistent across all clinical documents -
identifies and classifies the document, provides information on patient, provider, encounter, and authentication
– Body contains narrative text / multimedia content (level 1), optionally augmented by coded equivalents (levels 2 & 3)
10
CDA Standard• Release 1 (2000)
– Standalone standard– Based on draft v3 RIM– Level 1 narrative and multimedia
• Release 2 (2005)– Incorporated into HL7 v3 Standard (Normative Edition
just published on CD)– Level 2 narrative and multimedia, plus coded statements
• Implementation Guide for Care Record Summaries, US Realm (currently in ballot)
11
CDA Release 2 Information Model
Header Body
ParticipantsSections/Headings
Clinical Statements/Coded Entries
ExtlRefsContext
ID/Type
StartHere
12
CDA Structured Body
Structured Body
Section
Text
Section
Text
Section
Text
Section
Text
Section
Text
Section
Text
Entry
Coded statement
Entry
Coded statement
Entry
Coded statement
Arrows are Act Relationships • Has component, Derived from, etc.
Entries are coded clinical statements• Observation, Procedure, Substance administration, etc.
13
Clinical Document
Characteristics• Persistence– Documents exist over time and can be used in many contexts
• Stewardship– Documents must be managed, shared by the steward
• Potential for authentication– Intended use as medico-legal documentation
• Wholeness– Document includes its relevant context
• Human readability– Essential for human authentication
14
Sample CDA
15
Narrative and Coded Info• CDA requires human-readable “Narrative Block”, all
that is needed to reproduce the legally attested clinical content
• CDA allows optional machine-readable coded “Entries”, which drive automated processes
• Narrative may be flagged as derived from Entries – Textual rendering of coded entries’ content, and contains
no clinical content not derived from the entries • General method for coding clinical statements is a hard,
unsolved problem– CDA allows incremental improvement to amount of
coded data without breaking the model
16
Narrative and Coded Entry
Example
17
DICOM Structured ReportingOverview
18
DICOM Structured Reporting• The scope of DICOM SR is the
standardization of documents in the imaging environment.
• SR documents describe or reference images, waveforms, or specific regions of interest.
19
SR History• 1994 – initial discussions
• 1995 – Working Group 8 (Structured Reporting)• 1998 – Supplement 23 Structured Reporting draft• 1999-2000 – Supplement 23 adopted• 2001 – Supplement 53 DICOM Content Mapping
Resource adopted• 2001-2005 – 12 Supplements defining specific SR
document templates
20
SR Use Cases• Radiology reports with robust image / ROI
references• Measurements/analyses made on images• Computer-aided detection results• Notes about images (QC, flag for specific use, quick
reads)• Procedure logs for imaging-based therapeutic
procedures• Image exchange manifests
21
Use Case Common Features• Structured
– Lists and hierarchies
• Numeric measurements, coded values– Automatically extractable for database, data mining
• Relationships between items– Hierarchical, or arbitrary reference– Power of rich semantic expression
• References to images, waveforms, other objects– Collected in DICOM environment
• Explicit contextual information– Unambiguous documentation of meaning
22
Key Aspects of DICOM SR• SR documents are encoded using DICOM standard
data elements and leverage DICOM network services (storage, query/retrieve)
• SR uses DICOM Patient/Study/Series information model (header), plus hierarchical tree of “Content Items”
• Extensive use of coded content– Allows use of vocabulary/codes from non-DICOM sources
• Templates define content constraints for specific types of documents / reports
23
SR Content Item Tree
Root Content Item
Document Title
Content Item Content Item Content Item
Content Item Content Item Content Item
Arrows are parent-child relationships• Contains, Has properties, Inferred from, etc.
Content Items are units of meaning• Text, Numeric, Code, Image, Spatial coordinates, etc.
Content Item
Content Item Content Item
24
DICOM SR Objects• Basic Text
– Narrative text with image references• Enhanced and Comprehensive
– Text, coded content, and numeric measurements, spatial and temporal ROI references
• Mammo CAD and Chest CAD – Automated analysis results
• Key Object Selection (KO)– Flags one or more images or waveforms with purpose (for
referring physician, for surgery …) and textual note – Used for key image notes and image manifests (in IHE profiles)
• Procedure Log – For intravascular / cardiac cath
25
Radiology Reporting
26
Reporting Integration • Should be high priority
– Economic importance of radiologist productivity
– Referring physicians (radiology’s customers) want to see key images
• But, still mostly served by proprietary and custom integration
27
Reporting integration includes: • Workflow
– Managing interpretation worklists– Providing orders and relevant clinical information– Automatically displaying appropriate images and relevant
priors• Annotation and measurements
– Key images– Markings, measurement calipers and other graphical
annotation– Measurements acquired in the imaging procedure
• Structured reporting• Narrative reporting
28
The all-DICOM solution• DICOM SR, along with General Purpose Worklist, was
supposed to take care of all this.• DICOM SR has found vital uses in key subspecialty areas
that produce structured data in the examination or post-processing– Cardiology, both Cath Lab and Echo– Fetal biometry in ultrasound– Computer Aided Detection/Diagnosis results
These SR documents are not necessarily part of the patient’s medical record, but are part of the Evidence Data.
29
“Evidence” and “Reports”• Evidence Documents
– Include ultrasound measurements, cath lab procedure logs, Computer-Aided Diagnosis results, etc., that are created in the imaging context
– Together with images, are part of the information that a radiologist uses to produce a report
– The reporting physician may quote or copy parts of Evidence Documents into the report, but doing so is part of the interpretation process at the reporting physician’s discretion
– Appropriate to be stored with the images as DICOM SR objects
• Reports – Become part of the patient’s medical record, with potentially wide
distribution– Ideal match to HL7 CDA; structured/coded data requires CDA
Release 2
30
Reporting is RIS Turf• Diagnostic reporting continues in the province of
information systems that are based primarily on Health Level Seven (HL7) standards.
• Even if diagnostic reports were created as DICOM SR objects, the end recipients of diagnostic reports – referring physicians – commonly use systems with HL7 rather than DICOM capabilities.
31
DICOM-HL7 Synergy• SR and CDA developed simultaneously
• DICOM and HL7 working groups recognized the need to work together
DICOM SR and HL7 CDA are congruent in key areas– Document persistence
– Document identification, versioning and type code
– Document’s relation to the patient and to the authoring physicians
• In 2000 DICOM groups were already looking to CDA as a format for exporting DICOM SR content
– Proposal to translate SR documents into CDA, but would have to wait (a long time) for Release 2 Level 3 of CDA
32
DICOM Interest in CDA• Use cases for varying types and purposes of diagnostic
reporting elaborated at the DICOM 2002 Symposium. • March 2003: DICOM Working Group 10 (Strategic Advisory)
suggested composing the reports directly in CDA format. • Standards solutions were considered against the use cases, and
gaps were identified and subsequently closed through extensions to the standards.
• The efforts have included: – discussions in many working groups of DICOM– continued cooperation with the HL7 Structured Document Technical
Committee, which edits the CDA– the issuance of DICOM Supplement 101 (HL7 Structured Document
Object References)– CDA Implementation Guide for Diagnostic Reports [2006]
33
Standards Now Ready
• CDA Release 2 is now published [2005], and all needed standards are now in place.
• Additions to DICOM in Supplement 101 – Enable reference to CDA documents from within
DICOM objects– Include CDA documents on DICOM removable disks
• Indexed in DICOMDIR for integration with DICOM storage systems
– Communicate simple image references and annotation from PACS to reporting systems without requiring close integration of the two systems
34
Usercontrol
Diagnostic reporting
********************************************************************************
UNIVERSITY OF CHICAGO HOSPITALS
RADIOLOGY CONSULTATION
342 02/05/96
BHIS #: 1234567 INPATIENT 201-23-90
Hematology / Oncology CHANDLER, CAROLYN
Mitchell-6NE 49 FEMALE
Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Clinical data: Biliary tube check.
Carl M. Gompers, MD
Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96
COMPARISON: 07/23/95 and 06/27/95
FINDINGS: After the procedure was explained to the patient and informed
& Int -- Exam #47 on 02/05/96
FINDINGS: As above.
IMPRESSION:
Successful biliary tube change, and findings consistent with interval tumor
growth.
Simon A. Templar, MD / Richard Nixon, MD (R19)
Signed 02/9/96 at 8:48 AM
3
********************************************************************************
UNIVERSITY OF CHICAGO HOSPITALS
RADIOLOGY CONSULTATION
342 02/05/96
BHIS #: 1234567 INPATIENT 201-23-90
Hematology / Oncology CHANDLER, CAROLYN
Mitchell-6NE 49 FEMALE
Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Clinical data: Biliary tube check.
Carl M. Gompers, MD
Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96
COMPARISON: 07/23/95 and 06/27/95
FINDINGS: After the procedure was explained to the patient and informed
& Int -- Exam #47 on 02/05/96
FINDINGS: As above.
IMPRESSION:
Successful biliary tube change, and findings consistent with interval tumor
growth.
Simon A. Templar, MD / Richard Nixon, MD (R19)
Signed 02/9/96 at 8:48 AM
3
Image Viewing Application
Reporting Application
PACSArchive
Information System
Diagnosticreport
Report
ImageSources
Orders,Prior
Reports
DiagnosticImages
Viewingsettings
35
Reportwith imagereferences &annotation
Usercontrol
Reporting with annotation(use case)
********************************************************************************
UNIVERSITY OF CHICAGO HOSPITALS
RADIOLOGY CONSULTATION
342 02/05/96
BHIS #: 1234567 INPATIENT 201-23-90
Hematology / Oncology CHANDLER, CAROLYN
Mitchell-6NE 49 FEMALE
Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Clinical data: Biliary tube check.
Carl M. Gompers, MD
Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96
COMPARISON: 07/23/95 and 06/27/95
FINDINGS: After the procedure was explained to the patient and informed
& Int -- Exam #47 on 02/05/96
FINDINGS: As above.
IMPRESSION:
Successful biliary tube change, and findings consistent with interval tumor
growth.
Simon A. Templar, MD / Richard Nixon, MD (R19)
Signed 02/9/96 at 8:48 AM
3
********************************************************************************
UNIVERSITY OF CHICAGO HOSPITALS
RADIOLOGY CONSULTATION
342 02/05/96
BHIS #: 1234567 INPATIENT 201-23-90
Hematology / Oncology CHANDLER, CAROLYN
Mitchell-6NE 49 FEMALE
Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Clinical data: Biliary tube check.
Carl M. Gompers, MD
Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96
COMPARISON: 07/23/95 and 06/27/95
FINDINGS: After the procedure was explained to the patient and informed
& Int -- Exam #47 on 02/05/96
FINDINGS: As above.
IMPRESSION:
Successful biliary tube change, and findings consistent with interval tumor
growth.
Simon A. Templar, MD / Richard Nixon, MD (R19)
Signed 02/9/96 at 8:48 AM
3
Image Viewing Application
Reporting Application
PACSArchive
Information System
Diagnosticreport
ImageSources
DiagnosticImages
Imagereferences
& annotation
Viewingsettings
Orders,Prior
Reports
36
Usercontrol
Reporting with annotation(available)
********************************************************************************
UNIVERSITY OF CHICAGO HOSPITALS
RADIOLOGY CONSULTATION
342 02/05/96
BHIS #: 1234567 INPATIENT 201-23-90
Hematology / Oncology CHANDLER, CAROLYN
Mitchell-6NE 49 FEMALE
Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Clinical data: Biliary tube check.
Carl M. Gompers, MD
Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96
COMPARISON: 07/23/95 and 06/27/95
FINDINGS: After the procedure was explained to the patient and informed
& Int -- Exam #47 on 02/05/96
FINDINGS: As above.
IMPRESSION:
Successful biliary tube change, and findings consistent with interval tumor
growth.
Simon A. Templar, MD / Richard Nixon, MD (R19)
Signed 02/9/96 at 8:48 AM
3
********************************************************************************
UNIVERSITY OF CHICAGO HOSPITALS
RADIOLOGY CONSULTATION
342 02/05/96
BHIS #: 1234567 INPATIENT 201-23-90
Hematology / Oncology CHANDLER, CAROLYN
Mitchell-6NE 49 FEMALE
Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Clinical data: Biliary tube check.
Carl M. Gompers, MD
Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96
COMPARISON: 07/23/95 and 06/27/95
FINDINGS: After the procedure was explained to the patient and informed
& Int -- Exam #47 on 02/05/96
FINDINGS: As above.
IMPRESSION:
Successful biliary tube change, and findings consistent with interval tumor
growth.
Simon A. Templar, MD / Richard Nixon, MD (R19)
Signed 02/9/96 at 8:48 AM
3
Image Viewing Application
Reporting Application
PACSArchive
Information System
Diagnosticreport
Report
ImageSources
DiagnosticImages
Viewing settings,image references& annotation
Imagereferences
& annotation
Orders,Prior
Reports
37
Diagnosticreport
Integrated solutionImage Viewing &
Reporting Application
Integrated PACS &Information System
ImageSources
Orders,Diagnostic images
& Prior reports
Viewing settings,Reports, imagereferences & annotation
Imagereferences
& annotation
******************************************************************************** UNIVERSITY OF CHICAGO HOSPITALS RADIOLOGY CONSULTATION342 02/05/96BHIS #: 1234567 INPATIENT 201-23-90Hematology / Oncology CHANDLER, CAROLYNMitchell-6NE 49 FEMALE
Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIAClinical data: Biliary tube check. Carl M. Gompers, MD
Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96
COMPARISON: 07/23/95 and 06/27/95
FINDINGS: After the procedure was explained to the patient and informed& Int -- Exam #47 on 02/05/96
FINDINGS: As above. IMPRESSION:
Successful biliary tube change, and findings consistent with interval tumorgrowth.
Simon A. Templar, MD / Richard Nixon, MD (R19) Signed 02/9/96 at 8:48 AM3
******************************************************************************** UNIVERSITY OF CHICAGO HOSPITALS RADIOLOGY CONSULTATION342 02/05/96BHIS #: 1234567 INPATIENT 201-23-90Hematology / Oncology CHANDLER, CAROLYNMitchell-6NE 49 FEMALE
Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIAClinical data: Biliary tube check. Carl M. Gompers, MD
Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96
COMPARISON: 07/23/95 and 06/27/95
FINDINGS: After the procedure was explained to the patient and informed& Int -- Exam #47 on 02/05/96
FINDINGS: As above. IMPRESSION:
Successful biliary tube change, and findings consistent with interval tumorgrowth.
Simon A. Templar, MD / Richard Nixon, MD (R19) Signed 02/9/96 at 8:48 AM3
Usercontrol
38
Usercontrol
Loosely integrated reporting
********************************************************************************
UNIVERSITY OF CHICAGO HOSPITALS
RADIOLOGY CONSULTATION
342 02/05/96
BHIS #: 1234567 INPATIENT 201-23-90
Hematology / Oncology CHANDLER, CAROLYN
Mitchell-6NE 49 FEMALE
Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Clinical data: Biliary tube check.
Carl M. Gompers, MD
Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96
COMPARISON: 07/23/95 and 06/27/95
FINDINGS: After the procedure was explained to the patient and informed
& Int -- Exam #47 on 02/05/96
FINDINGS: As above.
IMPRESSION:
Successful biliary tube change, and findings consistent with interval tumor
growth.
Simon A. Templar, MD / Richard Nixon, MD (R19)
Signed 02/9/96 at 8:48 AM
3
********************************************************************************
UNIVERSITY OF CHICAGO HOSPITALS
RADIOLOGY CONSULTATION
342 02/05/96
BHIS #: 1234567 INPATIENT 201-23-90
Hematology / Oncology CHANDLER, CAROLYN
Mitchell-6NE 49 FEMALE
Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Clinical data: Biliary tube check.
Carl M. Gompers, MD
Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96
COMPARISON: 07/23/95 and 06/27/95
FINDINGS: After the procedure was explained to the patient and informed
& Int -- Exam #47 on 02/05/96
FINDINGS: As above.
IMPRESSION:
Successful biliary tube change, and findings consistent with interval tumor
growth.
Simon A. Templar, MD / Richard Nixon, MD (R19)
Signed 02/9/96 at 8:48 AM
3
Image Viewing Application
Reporting Application
PACSArchive
Information System
Diagnosticreport
Report
ImageSources
DiagnosticImages
Viewing settings,image references& annotation
Imagereferences
& annotation
Orders,Prior
Reports
39
Usercontrol
Loosely integrated reporting
********************************************************************************
UNIVERSITY OF CHICAGO HOSPITALS
RADIOLOGY CONSULTATION
342 02/05/96
BHIS #: 1234567 INPATIENT 201-23-90
Hematology / Oncology CHANDLER, CAROLYN
Mitchell-6NE 49 FEMALE
Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Clinical data: Biliary tube check.
Carl M. Gompers, MD
Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96
COMPARISON: 07/23/95 and 06/27/95
FINDINGS: After the procedure was explained to the patient and informed
& Int -- Exam #47 on 02/05/96
FINDINGS: As above.
IMPRESSION:
Successful biliary tube change, and findings consistent with interval tumor
growth.
Simon A. Templar, MD / Richard Nixon, MD (R19)
Signed 02/9/96 at 8:48 AM
3
********************************************************************************
UNIVERSITY OF CHICAGO HOSPITALS
RADIOLOGY CONSULTATION
342 02/05/96
BHIS #: 1234567 INPATIENT 201-23-90
Hematology / Oncology CHANDLER, CAROLYN
Mitchell-6NE 49 FEMALE
Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Clinical data: Biliary tube check.
Carl M. Gompers, MD
Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96
COMPARISON: 07/23/95 and 06/27/95
FINDINGS: After the procedure was explained to the patient and informed
& Int -- Exam #47 on 02/05/96
FINDINGS: As above.
IMPRESSION:
Successful biliary tube change, and findings consistent with interval tumor
growth.
Simon A. Templar, MD / Richard Nixon, MD (R19)
Signed 02/9/96 at 8:48 AM
3
Image Viewing Application
Reporting Application
PACSArchive
Information System
Diagnosticreport
Report
ImageSources
DiagnosticImages
Viewing settings,image references& annotation
Imagereferences
& annotation
Image references& annotation
Image retrieval
Orders,Prior
Reports
Transcribednarrative
Verification
Imageselection
Annotation
********************************************************************************
UNIVERSITY OF CHICAGO HOSPITALS
RADIOLOGY CONSULTATION
342 02/05/96
BHIS #: 1234567 INPATIENT 201-23-90
Hematology / Oncology CHANDLER, CAROLYN
Mitchell-6NE 49 FEMALE
Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Clinical data: Biliary tube check.
Carl M. Gompers, MD
Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96
COMPARISON: 07/23/95 and 06/27/95
FINDINGS: After the procedure was explained to the patient and informed
& Int -- Exam #47 on 02/05/96
FINDINGS: As above.
IMPRESSION:
Successful biliary tube change, and findings consistent with interval tumor
growth.
Simon A. Templar, MD / Richard Nixon, MD (R19)
Signed 02/9/96 at 8:48 AM
3
********************************************************************************
UNIVERSITY OF CHICAGO HOSPITALS
RADIOLOGY CONSULTATION
342 02/05/96
BHIS #: 1234567 INPATIENT 201-23-90
Hematology / Oncology CHANDLER, CAROLYN
Mitchell-6NE 49 FEMALE
Admitting Diagnosis: NEUTROPENIC FEVER; HYPERBILIRUBEMIA
Clinical data: Biliary tube check.
Carl M. Gompers, MD
Change Perc Biliary Drainage Cath Proced -- Exam #46 on 01/08/96
COMPARISON: 07/23/95 and 06/27/95
FINDINGS: After the procedure was explained to the patient and informed
& Int -- Exam #47 on 02/05/96
FINDINGS: As above.
IMPRESSION:
Successful biliary tube change, and findings consistent with interval tumor
growth.
Simon A. Templar, MD / Richard Nixon, MD (R19)
Signed 02/9/96 at 8:48 AM
3
Image Viewing Application Reporting Application
Image Archive(DICOM SCP)
Reporting SystemValidation Functions
Dictatedreport
DICOMKO object“For Report”
DICOM Query/Retrieve for all KO objects matching Accession Number
WADOServer
Reporting Integration Functions
CDAReport
SRReport
DICOM references to Images & GSPSs
WADO URI references to Images with GSPSs
DICOMGSPS object
41
CDA Implementation Guides• Balloted as HL7 Informative Documents
• Describe what amount to “templates” for CDA Documents.– Specify constraints on CDA content– Provide Schematron validation of instances– Each Implementation Guide has a Template ID attribute
that is included in the root element of the conforming document
• Care Record Summary IG being balloted• WG20/IISIG is preparing an IG for Diagnostic
Imaging Reports
42
Conclusions• CDA now being seen as primary format for diagnostic reports
– Supp 101’s definition of SR report and its equivalent CDA is most practical at this time, though the CDA structure is not normative text in DICOM
– Direct definition of CDA report to be done in 2006 by a balloted HL7 Implementation Guide
– Does not require tight integration of imaging and reporting workstations
– Method is extensible to reports with more structure
• DICOM SR will see continued and expanding use for Evidence Documents created in the imaging setting
– IHE Evidence Documents Integration Profile– Work under way for formalizing Evidence Documents as a separate
object class in DICOM