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HL7 CDA and DICOM SR Diagnostic Imaging Reports. Helmut Koenig, MD SIEMENS AG – Healthcare Sector Co-Chairman DICOM WG20 / HL7 Imaging Integration WG. HL7 CDA and DICOM SR Diagnostic Imaging Reports. Introduction Motivation

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hl7 cda and dicom sr diagnostic imaging reports

HL7 CDA and DICOM SR Diagnostic Imaging Reports

Helmut Koenig, MD

SIEMENS AG – Healthcare SectorCo-Chairman DICOM WG20 / HL7 Imaging Integration WG

hl7 cda and dicom sr diagnostic imaging reports2
HL7 CDA and DICOM SR Diagnostic Imaging Reports
  • Introduction
    • Motivation
    • Comparison of Structured Document Standards: DICOM SR vs. HL7 CDA Rel.2
  • Facilitation of Document Exchange between Imaging and Information Systems
    • Use Cases / Scenarios
    • Scope of SR Transformation Guide / CDA Implementation Guides
  • Conclusions
    • Strategies for Document Exchange

DICOM International Conference & Seminar

introduction 1
Introduction (1)
  • Structured Documents:
    • Provide the basis for extended search capabilities through:
      • Defined document structure and contents (e.g. through XML elements and attributes)
      • Use of terminologies (contolled vocabulary, defined semantics of concepts)
    • Individual and inter-individual evaluation of:
      • Outcome of imaging studies / procedures
      • Diagnoses…

CDA Snippet:

<observation classCode="DGIMG" moodCode="EVN">

<id root= “SOP Instance UID” />

<code code="SOP Class UID " codeSystem="1.2.840.10008.2.6.1“

codeSystemName="DCMUID" displayName="Computed Radiography Image Storage“/>

<effectiveTime value="20060823223232"/>

</observation>

DICOM International Conference & Seminar

introduction 2
Introduction (2)
  • Goal: Leverage Communication of Document-Based Imaging Results for Coordination of Clinical Tasks
    • Multiple Specialties in Intra- and Cross-Institutional Settings
    • Provision of Relevant Images, Image-Based Quantitative Measurements and Interpretation Results for Planning Diagnostic and Therapeutic Activities
  • DICOM WG20 created a set of harmonized Structured Document Standards
    • DICOM Supplement 135 „SR Diagnostic Imaging Report Transformation Guide” which will be included in the new DICOM part 20 “Transformation of DICOM to and from HL7 Standards”
    • HL7 CDA Diagnostic Imaging Report (DIR) Implementation Guide (focus: diagnostic imaging procedures)
    • HL7 CDA Procedure Note Implementation Guide (focus: image-guided interventions)

DICOM International Conference & Seminar

comparison dicom sr hl7 cda r2
Comparison DICOM SR / HL7 CDA R2
  • Structure of DICOM SR and HL7 CDA R2:
    • Analysis of SR Basic Diagnostic Imaging Report (Template 2000):
      • Essential Metadata, Document Structure, SR Imaging Service Data and Context Information can be represented and mapped to CDA R2. Not only as narrative text, but as structured document content.
      • Minimal Context Information on Subject (Patient/Fetus), Observer (Person/Device) and Procedure has been identified

DICOM SR

HL7 CDA R2

DICOM International Conference & Seminar

comparison dicom sr hl7 cda r26
Comparison DICOM SR / HL7 CDA R2

DICOM International Conference & Seminar

reporting workflow terms definitions
Reporting Workflow: Terms & Definitions
  • Evidence Document
    • Uninterpreted Information (Primarily Managed and Used Inside the Imaging Department)
    • Non-Image Information such as Measurements, CAD Results
    • Used in the Process of Creating a Radiological Diagnostic Report
  • Radiological Diagnostic Report
    • Interpreted Information, Primary Output of the Radiology Department
    • “Evidence Documents may be used either as additional evidence for the reporting physician or in some cases for selected items in the Evidence Document to be included in the diagnostic report.”
  • Clinical Document
    • May contain Results and Diagnoses from various Clinical Specialties
    • Radiological Diagnostic Report may be included in the Clinical Document

DICOM International Conference & Seminar

reporting workflow use cases scenarios
Reporting Workflow: Use Cases / Scenarios

CDA = Clinical Document Architecture

DIR = Diagnostic Imaging Report

KOS = Key Object Selection

SR = Structured Reporting

DICOM International Conference & Seminar

original cda r2 rmim
Original CDA R2 RMIM
  • Document Header
  • Related Acts: Encounter, Order, Parent
  • Document…
  • - Participations: PatientRole, Author…
  • Document Body
  • Section with Narrative Text
  • Structured Section Entries
  • External References

Section

DICOM International Conference & Seminar

cda document key elements
CDA Document Key Elements

<ClinicalDocument>

... <!--HEADER (PARTICIPATIONS, RELATED ACTS)-->

<structuredBody>

<section>

<text></text> <!--NARRATIVE BLOCK-->

</section>

<section>

<text>...</text>

<entry> <!--STRUCTURED ENTRIES-->

<observation>…</observation>

</entry>

</section>

</structuredBody>

</ClinicalDocument>

DICOM International Conference & Seminar

sample cda diagnosting imaging report 1
Sample CDA Diagnosting Imaging Report (1)

DICOM International Conference & Seminar

sample cda diagnosting imaging report 2
Sample CDA Diagnosting Imaging Report (2)

DICOM International Conference & Seminar

constrained cda model for imaging reports
Constrained CDA Model for Imaging Reports
  • Clinical Document Header
    • Relevant Participations (author, legal authenticator…)
    • Relevant document related acts (parent document, order, service event…)
    • Subject (record target/patient) and observer context (author)
  • Structured Body
    • Sections as top-level structure within structured body
    • Special DICOM object catalog section (information on all DICOM objects referenced within the document)
    • Section text (narrative block) contains attested content of the document
    • Relevant Clinical Statement Entries: “Observation” (Text and Code), “Procedure” and “Act” (part of procedure context)
    • entryRelationship Types used: “component”, “reason”, “subject”, “support”
    • WADO references to relevant DICOM objects (i.e. images)

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numeric measurements and image references
Numeric Measurements and Image References
  • CDA R2 Structured Representation

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conclusions
Conclusions
  • Represention of Essential SR Imaging Service Data and Context Information in CDA R2 is Possible
    • Document and Observation Context
    • Preservation of Structural Information, i.e. for Measurements based on Image Data and their Interpretation
  • Reuse of Identified Patterns for Other Document Types
  • Mapping Supports Communication of Structured Imaging Results and Diagnoses to HL7 Speaking Information Systems
  • Next Steps:
    • Work on RSNA CDA Report Templates in Cooperation with DICOM WG8

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acknowledgments
Acknowledgments
  • Contributions to Documents and Sample Materials:
    • L. Alschuler, R. Geimer, F. Behlen, PhD: CDA Diagnostic Imaging Report (DIR) Implementation Guide
    • D. Donker, PhD: CDA Sample Document + XSL Stylesheet
    • David S. Channin, MD: Basis for SR Sample Document, Sample Images
    • B. Dolin, MD and Members of HL7 Structured Documents WG: Guidance on CDA Standard and Term Info Patterns

DICOM International Conference & Seminar

references
References

http://medical.NEMA.org/

http://www.HL7.org/

http://www.IHE.net/

Thank you for your attention !

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backup slides
Backup Slides

DICOM International Conference & Seminar

glossary
Glossary

Acronyms:

CDA = Clinical Document Architecture

DIR = Diagnostic Imaging Report

GSPS = Grayscale Softcopy Presentation State

KOS = Key Object Selection

RMIM = Refined Message Information Model (HL7 Version 3)

SOP = Service Object Pair

SR = Structured Reporting

WADO = Web Access to DICOM Persistent Object (DICOM Part 18)

Terms & Definitions:

  • Evidence Document
    • Uninterpreted Information (Primarily Managed and Used Inside the Imaging Department)
    • Non-Image Information such as Measurements, CAD Results
    • Used in the Process of Creating a Radiological Diagnostic Report
  • Radiological Diagnostic Report
    • Interpreted Information, Primary Output of the Radiology Department
    • “Evidence Documents may be used either as additional evidence for the reporting physician or in some cases for selected items in the Evidence Document to be included in the diagnostic report.”
  • Clinical Document
    • May contain results and diagnoses from various clinical specialties
    • Radiological Diagnostic Report may be included in the Clinical Document

DICOM International Conference & Seminar

dicom reporting strategy

Clinical Summary

Report

Clinical

Clinical

Patient Medical

History / Relevant

Document

Document

Prior Documents

HL7 Message

2b) Imaging Report Import

(Transcoded for Inclusion

into CDA Clinical Summary

Report)

*

*

Specialized

Image Data

Order

Diagnostics/

Post

-

Processing

Interventions

Derived

Image

Obser

-

Image

Data

vations

Data

*

1a) Evidence Doc

Export (for CDA

Imaging Report)

SR

-

> CDA Rel.2

Transcoding

Evidence

Document

2a) SR Imaging Report

Export (for CDA Clinical

Summary Report)

CCOW Access

Interpretation

*

Convey relevant information

of clinical document

Observations

Conclusions

Diagnoses

On one or more

imaging procedures

1b) Evidence Doc Import

(Transcoded for Inclusion

into CDA Imaging Report)

,

HL7 CDA

Imaging

Report

DICOM SR

DICOM Reporting Strategy

DICOM International Conference & Seminar