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DICOM. HL 7. Health Level 7. Digital Imaging and Communication in Medicine. Radiologie. Administration. surgery documentation. Laboratory. Communication in a hospital. Communication in the past. Individual interface between ever two systems High developing costs

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dicom

DICOM

HL 7

Health Level 7

Digital Imaging and Communication in Medicine

communication in a hospital

Radiologie

Administration

surgery documentation

Laboratory

Communication in a hospital
communication in the past
Communicationin the past
  • Individual interface between ever two systems
  • High developing costs

n * (n-1) interfaces for n systems

  • extensive documentation
  • high maintenance costs
  • high expenditure with exchange of equipment
slide4
HL7

HL7 is an international community of healthcare subject matter experts and information scientists collaborating to create standards for the exchange, management and integration of electronic healthcare information. HL7 promotes the use of such standards within and among healthcare organizations to increase the effectiveness and efficiency of healthcare delivery for the benefit of all.

communication with hl7
Communication with HL7

In 1987 the USA a working group was established with the goal:

  • Supply of formats and protocols for data exchange in the health service
  • Standardization of the contents
  • More efficient communication
  • Standardized language
  • Reduction of the implementation expenditure
  • International Standard

http://hl7.org/

http://www.hl7.de/

messages
Messages
  • Aufnahme, Verlegung, Entlassung

(admission, discharge, transfer = ADT)

  • Anfragen (queries)
  • Untersuchungsergebnisse (result reports)
  • Buchhaltung / Finanzen (finance)
  • Patientenversorgung (patient care)
  • Terminplanung (scheduling)
  • Rezept (pharmacy prescription)

http://www.hl7.de/links/demodb/hl7v231.htm

events
Events

The transmission of the messages is triggered by events

Example:

A01 stationäre Aufnahme Admit

A02 Verlegung Transfer

A03 Entlassung Discharge

A08 Änderung Update

http://www.hl7.de/links/demodb/hl7v231event.htm

example

Radiologie

Administration

surgery documentation

Laboratory

Example

A01

A01

ACK

A01

ACK

ACK

example1

Administration

Laboratory

Example

Patient unknown

query message

response message

composition of messages
Composition of messages
  • Messages consists of segments and

begin with a

Message Segment Header MSH

  • Segments consists of an ordered sequence of fields

Fields can be mandatory or optional

a01 admit a patient
A01 ADMIT A PATIENT

MSH Message Header

EVN Event Type

PID Patient Identification

[PD1] Additional Demographics

[ { NK1 } ] Next of Kin /Associated Parties

PV1 Patient Visit

[ PV2 ] Patient Visit - Additional Info.

[ { DB1 } ] Disability Information

[ { OBX } ] Observation/Result

[ { AL1 } ] Allergy Information

[ { DG1 } ] Diagnosis Information

[ DRG ] Diagnosis Related Group

[ { --- PROCEDURE begin

PR1 Procedures

[{ROL}] Role

} ] --- PROCEDURE end

[ { GT1 } ] Guaranto

[ { --- INSURANCE begin

IN1 Insurance

[ IN2 ] Insurance Additional Info.

[ {IN3} ] Insurance Additional Info. - Cert.

} ] --- INSURANCE end

segments used in dumc adt messages
Segments Used in DUMC ADT Messages

AL1 Allergy Information

DG1 Diagnosis Information

EVN Event Type

MRG Merge Information

MSH Message Header

NK1 Next of Kin

OBX Observation

PID Patient Identification

PV1 Patient Visit

PV2 Patient Visit - Additional Information

ZAP DUMC Appointment Segment

ZID DUMC Patient Identification Extension

ZV1 DUMC Patient Visit Extension

example adt message admission of patients
Example ADT – messageadmission of patients

A01 - Admit a Patient

MSH|^~\&|DMCADT||RADIS1||199506281130||ADT^A01|DMCADT950628113012000|P|2.2|||NE

EVN|A01|199506281130|||MCKEL003

PID|||H89213||BOOP^BETTY^B||19091012|F|JOHN WRIGHT|W|3380 HIDDEN OAK AVE^^DURHAM^NC^27704||(919)555-7906|||U|UNK|241639|000000000

PV1||I|MIN^2411^01|3|||051001^MASSEY^E^WAYNE|||MRH||||C||||A||027|||||||||||||||||||A01||10|||199506281129

ZV1|S|I|N

DG1||||CAUDA EQUINA SYN.||W

DG1||||CAUDA EQUINA SYN.||A

http://www.hl7.de/links/demodb/hl7v231eventA01.htm

DUMC HL7 ADT Specifications

hl7 with xml
HL7 with XML
  • Simpler to read
  • Simpler to validate
  • Bute the messages are much more longer
    • Example :
      • ADT - A01 message 500 characters
      • ADT - A01 as XML 2127 characters

Example

cda clinical document architecture document hierarchy

Header

Header

Header

Header

Header

Header

Header

Header

Body

Body

Body

Body

Body

Body

Body

Body

CDAClinical Document Architecture Document Hierarchy

Level 1

Unconstrained CDA

General dianostic finding

Header

Level 2

Section Level

templates

Body

ECG finding

X - rax finding

Endoscopy finding

Level 3

Entry Level

templates

X - rax

CT

MRT

gastro

oesophago

dicom digital imaging and communication in medicine
DICOMDigital Imaging and Communication in Medicine
  • In the year 1983 the American college of Radiology (ACR) and the National Electrical Manufactures Association (NEMA) created a committee. The goal was to develop a standard for medical pictures.
  • In the year 1985 the first version of this standard was presented. The file format and electrical point to point a connection between two devices were defined.
  • In the year 1993, DICOM 3.0 a further developed standard was presented, which made communication possible between different partners over a network.

http://www.iftm.de/dicom/einfuehrung.htm

http://medical.nema.org/

goal of dicom standard
Goal ofDICOM Standard

The goal of the DICOM Standard is to achieve compatibility and improve workflow efficiency between imaging systems and other information systems in healthcare environments worldwide

Description of the semantics of instructions and the appropriate files.

Description of the range of the implemented standards

Support of the communication in the network

Open to new applications

Use of existing international standards if possible and preparation of own standards

http://medical.nema.org/

standards information object definition
StandardsInformation Object Definition

Abstract definition of objects for the transmission of digital medical images and information according these images

  • Normalized classes contain only attributes, which belong directly to the object; e.g.: the attributes of an x-ray
  • Compound classes can contain also attributes, which belong indirectly to the object; e.g. the patient data and diagnoses to the x-ray
standards service class specification
StandardsService Class Specification

Spezification of services:

A class of services joins one or more information objects with services that can be performed with these objects.

Examples of services:

Storing of data

Searching

Working lists

Printing

standards data dictionary
StandardsData Dictionary
  • centralized registry which defines the collection of all DICOM Data
  • For each element, the data dictionary specifies:

— its unique tag, which consists of a group and element number

— its name

— its value representation (character string, integer, etc)

— its value multiplicity (how many values per attribute)

standards data structure and semantics
StandardsData Structure and Semantics
  • specifies how DICOM applications construct and encode the Data Set information
    • For example specification of image compression
  • addresses the encoding rules necessary to construct a Data Stream
  • defines the semantics of a number of generic functions
standards message exchange
StandardsMessage Exchange

specifies both the service and protocol used by an application in a medical imaging environment to exchange Messages

standards message exchange1
StandardsMessage Exchange

This Standard defines:

— the operations and notifications made available to Service Classes

— rules to establish and terminate associations provided by the communications support and the impact on outstanding transactions

— rules that govern the exchange of Command requests and responses

— encoding rules necessary to construct Command Streams and Messages.

standards media storage application profiles
StandardsMedia Storage Application Profiles
  • specifies application specific subsets of the DICOM Standard to which an implementation may claim conformance.
  • Is required for the exchange of medical images and related data between different applications
standards storage functions and media formats for data interchange
StandardsStorage Functions and Media Formats for Data Interchange

facilitates the interchange of information between applications in medical environments by specifying:

  • A structure for describing the relationship between the media storage model and a specific physical media and media format.
  • Specific physical media characteristics and associated media formats.
standards conformance
StandardsConformance

defines principles that implementations claiming conformance to theStandard shall follow

  • specifies the general requirements which must be met by any implementation claiming conformance.
  • defines the structure of a Conformance Statement.
examples
Examples
  • PACS Picture Archiving and Communication System

http://www.vepro.com/USA/solutions/PACS.asp

RIS Radiologie Information System

http://www.kliniken-heidenheim.de/klinik/Kliniken_und_zentrale_Einrichtungen/Roentgendiagnostik/index.php

Integration

http://www.uni-mainz.de/FB/Medizin/Radiologie/agit/berichte/dicom2004/01_Bilddatenmanagement.pdf

http://www.hipax.de/start.htm