the history and future of dicom
TRANSCRIPT
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DICOM Anniversary Conference, Monday, September 22, 2003, 1:30 p.m.
The History and Future of
DICOM and HL7
Behlen^Fred^M^^PhDAmerican College of Radiology
Co-Chair, DICOM Working Group 20
Co-Chair, HL7 Imaging Integration SIG
President, LAI Technology, Homewood, IL LAI technology
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Today’s talk• History
– What is HL7?– Other SDOs, early connections
• Now– Comparative organizational structures– Connections and collaborations
• Future– Common information models– Information objects and services– CDA and reporting– Congruence, not coalescence
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Hospital Enterprise
Radiology
Exam context
Diagnostic Imaging in the
Patient Care Process
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Hospital Enterprise
Radiology
Exam context
Results,Images
Diagnostic Imaging in the
Patient Care Process
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Hospital Enterprise
Radiology
Exam context
Results,Images
Diagnostic Imaging in the
Patient Care Process
$, £, ¥, etc.
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Administrative HIS/RIS
. . .
Medical Informatics
Scope ofDICOM
DiagnosticImaging
Lab Data
. . .
PatientBedside
Monitoring
Scope of Standards
Scope ofHL7
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Disagreements in Healthcare
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Origins ANSI
HISPP SCAMC (AMIA)
Harmonization SessionsHL7
ACR/NEMA
HISPP MSDS
CEN TC251
ANSI JWGDIC
ISIS
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DICOM-HL7 relationship
1996 IMSIG formed1999 DICOM proposes joint WG2000 DICOM WG20 formed, meets in
common with IMSIG (renamed IISIG)2001 DICOM & HL7 execute Memorandum
of Understanding2003 HL7 Version 2.5 Order Message for
Imaging (OMI)
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HL7• ANSI-accredited standards development
organization, formed in 1987• 16+ year old membership organization
– 512 organizations– 862 individual members
• 14 Technical Committees (TCs)• 17 Special Interest Groups (SIGs)• 22 international affiliates• 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)
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HL7
• 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
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WG6
DSC
WGxx
Board ofDirectors
TSC
TCs
SIGs
1n
11
1
1
1n 1
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Work items
Ballots
Charters
Ballots
DICOM HL7
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WG6
DSC
WGxx
Board ofDirectors
TSC
TCs
SIGs
1n
11
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Work items,Policy
Ballots
Charters
Ballots
IISIGWG20. . . . . .
DICOM HL7
Policy
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• 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
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OMI Message Use Case
OMImessage
used
OrderEntry
Imaging DepartmentInformation System
Imaging DepartmentInformation System
ImagingModality(Device)
ImagingModality(Device)
ImagingModality(Device)
Enterprise
Imaging Department
DICOM
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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 RequestedProcedure ID]
Requested Procedure 3[IPC-2 Requested Procedure ID]
Procedure Step 1[IPC-4 RequestedProcedure Step ID]
ProcedureStep 1[IPC-4RequestedProcedureStep ID]
ProcedureStep 2[IPC-4RequestedProcedureStep ID]
Requested Procedure 1[IPC-2 RequestedProcedure ID]
Procedure Step 1[IPC-4 RequestedProcedure Step ID]
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HL7 Version 3• First HL7 standard based on explicit information model
(the “RIM”)• Uses automated tooling to manage complexity• Components
– 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
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Communication
dog
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Communication
dog
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Patient
V isit
Study
Study ContentNotification
makes has
describes
includes
StudyComponents
M odality PerformedProcedure Steps
Comprisedof
Comprisedof
includes includes contains See Note
R esults
contains
R eport
LookupTable
StoredPrint
R adiotherapyObjects
1-n
1
0-n
1
1-n
1
1
1-n1
1
1-n
1-n
1-n
1 1 1
0-n
0-n0-n
1-n
0-n
1
0-1
0-n
Series
Frame ofR eference
creates
SpatiallyDefines
Equipment
1-n 1-n 1-n
1-n
1-n
0-1
1
Curve
Overlay
0-n
Image
A mmendment
0-n
contains
1
Patient& visit
Study &acquisition
Storeddata
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Patient IOD
V isit IOD
Study IOD
Basic StudyDescriptor IOD
references references
describes
references
Study ComponentIOD
M odality PerformedProc. Step IOD
Comprisedof
Comprisedof
references references references See Note
Results IOD
references
Interpretation IODImage IOD
Standalone CurveIOD
Standalone OverlayIOD
Standalone M odalityLUT IOD
Standalone V OI LU TIOD
Stored Print IODSee Figure 7.2b
R adiotherapy IODsSee Figure 7.2c
1-n
1
0-n
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1
1-n
1-n
1-n
1 1 1
0-n 0-n
0-n0-n0-n
1-n
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0-10-n
Patient& visitIODs
Study &acquisitionIODs
StoreddataIODs
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Message
Message
Mes
sage
Message
Mes
sage
Mes
sage
Message
Message
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Referralauthorized_visits _qty : REALdesc : 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>rate_qty : IVL<PQ>dose_check_qty : SET<RTO>max_dose_qty : SET<RTO>approach_site_cd : SET<CD>substitution_cd : CV
Procedure
approach_site_cd : SET<CD>method_cd : SET<CV>target_s ite_cd : SET<CD>
Supply
qty : PQ
Dietenergy_qty : PQcarbohydrate_qty : PQ
Consent
Clinical_documentcompletion_cd : CVs et_id : I Is torage_cd : CVvers ion_ nbr : INTcopy_time : TSchange_reason_cd : CV
Containercapacity_qty : PQheight_qty : PQdiameter_qty : PQbarrier_delta_qty : PQbottom_delta_qty : PQseparator_type_cd : CDcap_type_cd : CD
Accessgauge_qty : PQapproach_site_cd : CDtarget_site_cd : CD
Devicemanufacturer_model_nm : STlast_cal ibration_tim e : TSs oftware _nm : STlocal_remote_control_state_cd : CEalert_ level_cd : CE
Employee
hazard_ exposure_txt : EDjob_class_cd : CVjob_title_nm : STprotective_equipment_txt : EDsalary_qty : MOsalary_type_cd : C Vjob_cd : CE
Living_subject
birth_time : TSdeceased_time : TSdeceased_ind : BLadminis trative_gender_cd : CEorgan_donor_ind : BLm ul tiple_bi rth_ind : BLbirth_order _nbr : INT
Mater ial
form_cd : CVeffective_time : IVL<TS>
Assigned_practitioner
position_cd : CVprimary_care_ind : BL
Certified_practitionerboard_certification_type_cd : CVrecertification_time : TS
Place
gps_txt : STposition_txt : EDaddr : ADdirections_txt : EDmobile_ind : BL
Manufactured_material
expiration_time : TSlot_nm : STstability_time : IVL<TS>
Inpatient_encounter
length _of_stay_qty : PQ
Non_Person_living_subjecttaxonomic_class ification_cd : CEbreed_cd : CEstra in_txt : EDeuthana sia_ ind : BLproducti on_class_cd : CEgender_s tatus_cd : CE
Patientconfidentiality_cd : CVvery_important_person_cd : CV
Organizationstandard_industry_class_cd : CEaddr : SET<AD>
Account
allowed_balance_qty : IVL<MO>currency_cd : C Vinterest_rate_qty : RTOnm : ST
Qualified_practitioner
fellowship_field_cd : CEresidency_field_cd : CE
Financial_act
net_qty : MO
Persondisabil ity_cd : CEethnic_group_cd : SET<CV>race_cd : SET<CV>ambulatory_status_cd : CVeducation_level_cd : CVliving_arrangement_cd : CVmarital_status_cd : CVreligious_affiliation_cd : CVaddr : SET<AD>specia l_accommodation_cd : SET<CV>mothers_maiden_nm : ST
Working_list
ownership_level_cd : CV
Public_health_case
detection_method_cd : CEtransmiss ion_mode_cd : CEdisease_imported_cd : CE
Outbreak
time : IVL<TS>
Transportation
Patient_encounterdis charge_disposition_cd : CVacuity_level_cd : CVbirth_encounter_ind : BLstatus_reason_cd : CVvaluables_desc : EDpre_admit_test_ind : BLreferral_source_cd : CVspecial_courtesies_cd : CVvaluables_location_desc : EDadm ission_s ource_cd : CVaccident_cd : CVurgency_cd : CV
Schedulable_resources lot_size_increment_qty : PQ
Resource_slot
slot_time : GTS
Acts (Financial)
Acts (Services)
Infrastructure (Structured documents)
HEALTH LEVEL 7 REFERENCE INFORMATION MODEL RIM_0110Version 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
Bil lboard produced by:Rochester Outdoor Advertis ing
Roles
Guarantorcredit_rating_cd : CV
Diagnostic_image
subject_orientation_cd : CV
Imaging_modalitypixel_padding_qty : PQpixel_intensity_relationship_cd : CVspacial_resolution_qty : PQ
Query_ack
id : IIquery_status_cd : CVmessage_query_cd : CVresult_count_total : INTresult_count_current : INTresult_count_remaining : INT
Get_more_resultsquery_id : IIquantity : INTstart_result_nbr : INT
Query_message_interaction
Table
rules : CScellspacing : STcellpadding : 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 : CSdescriptor : STrender : ST
Li nk_html
title : STname : SThref : EDrel : SET<CE>rev : SET<CE>
Entry
local_id : ST
0. .1
0. .*
contains0. .1
is_contained _in0. .*
Context_structure
local_id : ST
0..*
0.. 1
is_contained_in
0..*
contai ns
0.. 1
Infrastructure (Structured documents)
Infrastructure (Message control)
Enitites
Message Control
Covered_party
handicap_cd : CVstudent_ind : BL
Act_relationshiptype_cd : CSinversion_ind : BLsequence_nbr : INTpriority_nbr : INTpause_qty : PQcheckpoint_cd : CSsplit_cd : CSjo in_cd : CSnegation_ind : BLconjunction_cd : CS
Act_context
level_cd : CVlanguage_cd : CS
File_of_batchcontrol_ id : IIname : STcreation_tim e : TSreference_control_id : IIsending_appl ica tion_id : IIreceiving_application_id : IIsecurity : STfile_batch_count : INTfile_co mment : SET<ST>
Act
id : SET<II>mood_cd : CSclass_cd : CStxt : EDstatus_cd : CSactivity_time : GTSeffective_time : GTSconfidentiality_cd : SET<CV>repeat_nbr : IVL<INT>interruptible_ind : BLpriority_cd : SET<CV>independent_ind : BLavailability_time : TScd : CDreas on_cd : CVstatus_time : TS
0..*1
has_target
0..*
is_target_for
1
0..*1
has_source
0..*
is_source_for
1
1..*
0..*
originates_in_context_of
1..*
prov ides_context_f or
0..*
Attention_linekey_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..*
conta ins
0..1
is_contained_by
0..*
Acknowledgementtype_cd : CVnote_txt : EDerror_detail_cd : CVexpected_sequence_nbr : INT
Message_interaction
message_type_id : IIresponse_cd : CS
Participation
type_cd : CStime : IVL<TS>note_txt : EDs ignatur e_cd : CVfunction_cd : CDawareness_cd : CVs ignatur e_txt : EDencounter_accom modation_cd : CVstatus_cd : CSmode_cd : CVsequence_nbr : INT
0. .* 1
for
0. .*
has
1
Relationship_link
effective_time : IVL<TS>type_cd : CS
Messagesending_application_id : IIid : SET<II>creation_time : TSinteraction_id : IIversion_id : STprofile_id : SET<OID>process ing_cd : CVsequence_nbr : INTreply_to_com : TELreceiving_application_id : SET<II>process ing_mode_cd : CVattachment_txt : EDaccept_ack_cd : CVapplication_ack_cd : CV
0..*1
can_ac company
0..*
can_include
1
0..1
0..*
contains
0..1
is_contained_by
0..*
1..*
1
acknowledges1..*
is _acknowl edged_by1
0..1
1
occurs_with0..1
has 1
0..1
0..*
is_communicated_as0..1
has_payload0..*
Roleclass_cd : CSeffective_time : IVL<TS>id : SET<II>s tatus_cd : CSposition_nbr : LIST<INT>qty : RTOcertificate_txt : EDaddr : SET<AD>telecom : SET<TEL>cd : CE
0..*1
has_as_parti cipant
0..*
participates_i n
1
0..*1
has_source
0..*
is_source_for
1
0..*1
has_target
0..*
is_target_for
1
Entity
id : SET<II>class_cd : CSdeterminer_cd : CSimportance_status_txt : EDqty : SET<PQ>telecom : SET<TEL>desc : EDstatus_cd : CScd : CEnm : SET<EN>risk_cd : CEhandling_cd : CE
1..*
0.. *
shall_receive 1..*
h as_ re cip ient
0.. *
1..1
0..*
sends 1..1
has_sender
0..*
0. .*0 .. 1
played_by
0. .*
pla ys
0.. 1
0. .*0.. 1
is_scoped_by
0. .*
scopes
0.. 1
Language_communication
language_cd : CEpreference_ind : BLmode_c d : CVproficiency_level_cd : CV
10 ..*
communicates_with
1
used_by
0 ..*
Financial_transactionpayment_terms_cd : CVdebit_exchange_rate_qty : RTOcredit_exchange_rate_qty : RTOinterest_rate_qty : RTO
Invoice_elementitem_nbr : REALitem_qualifier_cd : CEgross_qty : MOcoverage_source_cd : CEunit_qty : RTOnotify_subject_ind : BLmodifier_cd : CEfactor_nbr : REALpoints_nbr : REAL
Financial_contract
paym ent_terms_cd : CV
Role_heirEntity_heir
Sort_control
element_name : STsequence_nbr : INTdirection_cd : CV
Querymessage_query_cd : CVid : IIpriority : CVmodify_indicator : CVexecution_a nd_delivery_time : TSin itia l_qty : PQres ponse_modality_cd : CVreturn_element_group : SET<CV>
0..* 1
is_fo r
0 ..*
has
1
Relational_expressi on
element_name : STvalue : STrelational_operator_cd : CV
Query_by_selection
Selection_expression0..*
1
is_for 0..*
has_ex press ion 1
Logical_expression
relational_conjunction_cd : CV
1
0..*
has_left_side
1
is_lhs_for0..*
1
0..*
has_right_side
1
is _rhs_fo r0..*
Query_by_parameter
Parameter_list
Param eter
name : ST
0..*
1
is_parameter_of0..*
has 1
0..1
0..*
may_contain0..1
i s_part_of
0 ..*
A_parameter
value : ANY
Device_task
param eter_value : LIST<ANY>
Entity Role Participation Act
Message Control
Document Structures
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Imaging Order R-MIM
Entity
Act
Participation
Act Relationship
Role CMET (Common Message Element Type)
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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
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HL7 Clinical Document
Architecture (CDA)• Level 1– Coded header, text content with simple
formatting objects(section, paragraph, list, table)
• Level 2– Standard codes for Level 1 sections
• Level 3– Full structured content derived from RIM
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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
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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
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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)
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HL7 Templates
• 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
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A Number of Connections
• WG20 / IISIG Other HL7 groups– Technical Committees
• Orders & Observations• Vocabulary• Structured Documents• Laboratory Automation and Point of Care Testing• Patient Care• Control/Query
– Special Interest Groups• Conformance• Electronic Health Records (EHR)• Security & Accountability• Templates
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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
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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