The History and Future of DICOM and HL7

DICOM-HL7 relationship1996 IMSIG formed 1999 DICOM proposes joint WG 2000 DICOM WG20 formed, meets in common with IMSIG renamed IISIG 2001 DICOM & HL7 execute Memorandum of Understandi

DICOM Anniversary Conference, Monday, September 22, 2003, 1:30 p.m.

The History and Future of

DICOM and HL7

Behlen^Fred^M^^PhD

American College of Radiology

Co-Chair, DICOM Working Group 20 Co-Chair, HL7 Imaging Integration SIG President, LAI Technology, Homewood, IL LAI technology

1 1 1 1

– Common information models

– Information objects and services

– CDA and reporting

– Congruence, not coalescence

Diagnostic Imaging in the Patient Care Process

Diagnostic Imaging in the Patient Care Process

$, £, ¥,

etc.

Administrative HIS/RIS

Medical Informatics

Scope of DICOM

Diagnostic Imaging

Lab Data

.

Patient Bedside Monitoring

Disagreements in Healthcare

ANSI HISPP SCAMC (AMIA)

ANSI JWGDIC ISIS

DICOM-HL7 relationship

1996 IMSIG formed

1999 DICOM proposes joint WG

2000 DICOM WG20 formed, meets in

common with IMSIG (renamed IISIG)

2001 DICOM & HL7 execute Memorandum

of Understanding

2003 HL7 Version 2.5 Order Message for

Imaging (OMI)

• A week of working group meetings 3 times

annually, about 400 people attending more than 25 parallel sessions and tutorials

2119 voting members (Nov 2001)

HL 7

• Special projects on drug information,

adverse event reporting, genomic

encoding, admin simplification, public

health surveillance, practice guidelines, EHR and more

• Working relationships with ASTM, CEN, DICOM, ebXML, GEHR, IEEE, LOINC, OASIS, SNOMED, X12, W3C and others

DSC

WGxx

Board of Directors

TSC

TCs

SIGs

1 n

1 1 1

DSC

WGxx

Board of Directors

TSC

TCs

SIGs

1 n

1 1 1

1

Work items, Policy

Ballots

Charters

Ballots

IISIG WG20

Policy

• Version 2.5

– Order Message for Imaging (OMI)

• Version 3

– Representing DICOM Procedure Model

– Messages for imaging orders and reports

• Clinical Document Architecture (CDA)

– Transforming DICOM SR into CDA documents – Diagnostic reporting in CDA format

IISIG/WG20 Work Areas

OMI Message Use Case

OMI message used

Order Entry

Imaging Department Information System

Imaging Department Information System

Imaging Modality (Device)

Imaging Modality (Device)

Imaging Modality (Device)

Enterprise

Imaging Department

DICOM

Hierarchy in OMI message

Order

[ORC-2 Placer Order Number] – [ORC-3 Filler Order Number]

Imaging Service Request

[IPC-1 Accession Number]

Requested Procedure 2

[IPC-2 Requested Procedure ID]

Requested Procedure 3

[IPC-2 Requested Procedure ID]

Procedure Step 1

[IPC-4 Requested Procedure Step ID]

Procedure Step 1

[IPC-4 Requested Procedure Step ID]

Procedure Step 2

[IPC-4 Requested Procedure Step ID]

– Reference Information Model (RIM)

– Clinical Document Architecture (CDA)

– Version 3 Messaging

• Uses XML encoding

• High degree of compatibility with DICOM

• Extensive use of OIDs (cf UIDs)

• Will change I.S market as much as DICOM 3.0 changed imaging market, mostly through CDA

dog

dog

Study

Study Content Notification

makes has

describes includes

Study Components

Modality Performed Procedure Steps

1-n 1

1-n 1-n

0-n

0-n 0-n

creates

Spatially Defines

Equipment

1-n

1-n 0-1

Patient IOD

Visit IOD

Study IOD

Basic Study Descriptor IOD

references references

describes references

Study Component IOD

Modality Performed Proc Step IOD

Comprised of

Comprised of

references references references See Note

Results IOD

references

Interpretation IOD Image IOD

Standalone Curve IOD

Standalone Overlay IOD

Standalone Modality LUT IOD

Standalone VOI LUT IOD

Stored Print IOD See Figure 7.2b

Radiotherapy IODs See Figure 7.2c

1-n 1

0-n

1 1-n

1-n 1-n

0-n 0-n

0-n 0-n

0-n

1-n 0-n

1

0-1 0-n

ess

age

authorized_visits _qty : R EALdes c : EDreason_txt : ED

Observation

value : ANYderivation_expr : STmethod_cd : SET<CV>

target_s ite_cd : SET<CD>

interpretation_cd : SET<CS>

Substance_administration

route_cd : CDdose_qty : IVL<PQ>

c opy_time : TS

c hange_reason_cd : CV

Container

capacity_qty : PQheight_qty : PQdiam eter_qty : PQbarrier_delta_qty : PQseparator_type_cd : CDcap_type_cd : CD

Access

gauge_qty : PQapproach_site_cd : CDtarget_site_cd : CD

Device

m anufacturer_m odel_nm : STlast_calibration_tim e : TS

s oftware _nm : STlocal_remote_control_state_cd : CEalert_level_ cd : CE

Employee

hazard_exposure_txt : EDjob_clas s_cd : C Vjob_title_nm : STprotective_equipment_txt : EDsalary_qty : MOsalary_type_cd : C Vjob_cd : CE

Assigned_practitioner

position_cd : CVprimary_care_ind : BL

Certified_practitioner

board_certification_type_cd : CVrecertification_tim e : TS

Place

gps _txt : STpos ition_txt : EDaddr : ADdirections_txt : EDmobile_ind : BL

Manufactured_material

expiration_time : TSlot_nm : STstability_time : IVL<TS>

Organization

standard_indus try_class_cd : CEaddr : SET<AD>

Account

allowed_balance_qty : IVL<MO>currenc y_cd : C V

in teres t_rate_qty : RTO

Infrastructure (Structured documents)

HEALTH LEVEL 7

REFERENCE INFORMATION MODEL

RIM_0110

Version is basis for first committee-level ballots of Version 3 It

was released July 2001, and reflects RIM changes through

Harmonization on 07/20/2001

Billboard produced by:

Rochester Outdoor Advertising

s pacial_resolution_qty : PQ

Query_ack

id : IIquery_s tatus_cd : CVmess age_query_cd : CVresult_count_total : INTresult_count_current : INTresult_count_rem aining : INT

Get_more_results

query_id : IIquantity : INTstart_result_nbr : INT

Query_message_interaction

Table

rules : CScellspacing : STsumm ary : STwidth : STborder : INTframe : CS

Table_structure

halign : CSchar : STcharoff : STvalign : CSlocal_id : ST

Table_column_structure

span : INTwidth : ST

Table_cell

rowspan : INTcolspan : INTabbr : STaxis : STheaders : SET<ED>

scope : CS

Link Character_data

value : ST

Local_attr

name : STvalue : ST

Local_markup

ignore_cd : CSrender : ST

Li nk_html

title : STname : SThref : EDrel : SET<CE>

rev : SET<CE>

Entry

local_id : ST

0 1 0 *

contains 0 1 is_contained_in 0 *

contai ns 0 1

Act_context

language_cd : CS

File_of_batch

control_id : IIname : STcreation_tim e : TSreference_control_id : II

s ending_application_id : IIreceiving_application_id : II

s ecurity : STfile_batch_count : INTfile_comment : SET<ST>

Act

id : SET<II>

mood_cd : CStxt : EDstatus_cd : CSactivity_time : GTSeffective_tim e : GTSconfidentiality_cd : SET<CV>

repeat_nbr : IVL<INT>

interruptible_ind : BLpriority_cd : SET<CV>

independent_ind : BLavailability_time : TS

cd : CDreason_cd : CVstatus_time : TS

0 *

1has_target0 *

is_target_for1

0 *

1

has_source0 *

prov ides_context_f or0 *

Attention_line

key_word_txt : STvalue : ST

Batch

control_id : IIname : STcreation_time : TSreference_control_id : IIsending_application_id : IIreceiving_application_id : IIsecurity : STmessage_count : INTbatch_totals : SET<INT>

batch_comment : SET<ST>

0 10 *

contains0 1is_contained_by0 *

Acknowledgement

type_cd : CVerror_detail_cd : CVexpected_sequence_nbr : INT

Message_interaction

message_type_id : IIresponse_cd : CS

Participation

type_cd : CStime : IVL<TS>

note_txt : EDsignature_cd : CVfunction_cd : CDawarenes s_cd : CVsignature_txt : EDencounter_accom modation_cd : CVstatus_cd : CSsequence_nbr : INT

for0 *

has1

process ing_cd : CVreceiving_application_id : SET<II>

process ing_mode_cd : CVattachment_txt : EDaccept_ack_cd : CVapplication_ack_cd : CV

0 *

1

c an_ac company0 *

can_include1

0 10 *

contains0 1is_contained_by

0 *

1 *

1acknowledges1 *

is _ackn owled ged_b y10 11occurs_with0 1has 1

id : SET<II>

s tatus_cd : CSposition_nbr : LIST<INT>

qty : RTOcertificate_txt : EDaddr : SET<AD>

participates_in1

0 *

1has_source0 *

is_source_for10 *

1has_target0 *

is_target_for1

Entity

id : SET<II>

class_cd : CSdeterminer_cd : CSimportance_status _txt : EDqty : SET<PQ>

telecom : SET<TEL>

des c : EDstatus_cd : CS

cd : CE

nm : SET<EN>

risk_cd : CEhandling_cd : CE

1 *

0 *

shall_receive 1 *

h as_ recipient0 *

1 1

0 *

sends 1 1

has_sender0 *

0 *

0 1

played_by0 *

pla ys0 1

0 *

0 1

is_scoped_by0 *

scopes0 1

Language_communication

language_cd : CEpreference_ind : BLmode_c d : CVproficiency_level _cd : CV 0 * 1

communicates_with 1 used_by 0 *

Financial_transaction

payment_terms _cd : CVdebit_exchange_rate_qty : RTOcredit_exchange_rate_qty : RTOinterest_rate_qty : RTO

Invoice_element

item_nbr : REALitem_qualifier_cd : CEgross_qty : MOcoverage_s ource_cd : CEunit_qty : RTOnotify_subject_ind : BL

m odifier_cd : CEfactor_nbr : REALpoints_nbr : REAL

Financial_contract

paym ent_terms _cd : CV

Role_heir Entity_heir

Sort_control

element_name : STdirection_cd : CV

Query

mess age_query_cd : CV

id : IIpriority : CVmodify_indicator : CVexecution_and_delivery_time : TSinitial_qty : PQres ponse_modality_cd : CVreturn_element_g roup : SET<CV>

0 * 1is_for0 *

has1

Rel ational_expressi on

elem ent_name : STvalue : STrelational_operator_cd : CV

Query_by_selection Selection_expression0 *

1is_for0 *

has_ex pression1

Logical_expression

relational_conjunction_cd : CV

10 *

has_left_side1is_lhs_for0 *

10 *

has_right_side1

has 1

0 10 *

may_contain0 1

is_part_of0 *

A_parameter

value : ANY

Device_task

param eter_value : LIST<ANY>

Message Control

Document Structures

Ima ging Ord

er R- MI M

The HL7 Clinical Document Architecture (CDA)

• CDA header

– RIM-derived

– Ground up compatibility with DICOM SR

• CDA Level One body

– Based on subset of XHTML, fits any report type – Has image link, coded vocabulary

• CDA Release 2 body

– Permits data representation at various levels of granularity

– Passed first Committee ballot August 2003

– Member ballot March 2004

HL7 Clinical Document Architecture (CDA)

• Level 1

– Coded header, text content with simple

formatting objects(section, paragraph, list, table)

HL7 Clinical Document Architecture (CDA) Release 2

• Release 1

– Coded header, text content with simple

formatting objects(section, paragraph, list, table)

• Release 2

– Standard codes for Level 1 sections

– Full structured content derived from RIM

Release 2 CDA

• Release 2, Level One:

– alignment with current RIM, V3

methodology – minor enhancements to CDA Header – added functionality for CDA Body

• Region of interest (cf DICOM SCOORD)

• Release 2, Levels Two and Three

– templates layered on basic XML spec

• Level Two: templates for headings

• Level Three: templates for contents

– enables detailed clinical encoding

CDA Implementations

• National & International

– PICNIC (European Union)

– SCIPHOX (Germany)

– HYGEIAnet/WebOnColl (Greece)

– NHS South Staffordshire (United Kingdom)

– Satakunta Macro Pilot (Finland)

– e-Claims Supporting Document Architecture (Canada)

• Local & Regional

– Mayo Clinic (USA)

– Buenos Aires project (Argentina)

– Dalhousie U, QEII Health Sci Ctr (Canada)

HL7 Tem plat es

• Joint project of Templates SIG, Structured Documents TC, Conformance SIG

• Open template registry/repository

– will contain normative and non-normative

templates

• Tools for generating and validating

templates will be developed

• This will take a while

• Electronic Health Records (EHR)

• Security & Accountability

• Templates

More Connections

• WG14  SASIG  NEMA SPC

 IHE

• IHE  Conformance SIG

• DICOM  ISO @ HL7 venues

– WG10  TC215/WG2

– WADO  TC215/WG2

• Also WADO  Structured Documents TC

A Rewarding Partnership

• No big turf issues

– DICOM doesn’t want to define enterprise communications

– HL7 has no ambition or bandwidth to model specialty domain detail

• Each can learn from the other

– DICOM experience with persistent objects – HL7 experience with modeling tools

• HL7 meetings are a good gathering place