Sharing Images without CDs, The Next Imaging Sea Change

1. Sharing Images without CDs, The Next Imaging Sea Change GE Healthcare • Chris Lindop • GE Healthcare • Interoperability & Standards

2. In the Beginning:Film

3. In the beginning…. open image exchange started with one reliable method: FILM Advantage: Everyone can view the Film Issue: to be solved: Inconsistent visual quality Annotations, notes, etc. were attached “stuck-on” IHE Solution: Consistent Presentation of Images (CPI) Integration Profile Grayscale Standard Display Function (consistent images) Grayscale Softcopy Presentation State (Annotations) Film – the First Standard for Image Exchange

4. Radiology Enters the Digital Image Exchange:Portable Media: CDs

5. CDs or coasters? Then came the introduction of CDs and other portable media, but for most, was simply coasters for your morning coffee. Issues to be solve: Media in-compatibility Inconsistent viewer capabilities No import method to reviewer’s view station IHE Solution: Portable Data for Imaging (PDI) – Standard media format Basic Image Review (BIR) – Basic Viewer capability requirements Import Reconciliation Workflow (IRWF) – Standard import method Portable Media– the next interop challenge

6. Electronic Images Sharing beyond your Institution The Image Exchange

7. Use of a shared XDS Community-based infrastructure to access Radiology Reports and Images (XDS-I) • Between Radiology and : • Imaging specialists • Non-imaging clinicians • Patients Hospital PACS Y Radiology -to-Radiology Radiology –to – Physicians PACS Z Imaging Center Physician Practice Specifies how Radiology Information Objects, Both DICOM Instances and non-DICOM Reports are distributed in an eHealth Community 7

8. XDS Affinity Domain Considerations Set of organizations/systems organized around a single Registry Common set of Codes Single Patient ID Domain Involves business and legal agreements Security model/agreements

9. IHE Integration Profiles for Health Info NetsWhat is available and in trial implementation Basic Patients Privacy Consents Emergency Referrals PHR Extracts/Updates Format of the Document Content and associated coded vocabulary Establish Consents & Enable Access Control Patient Demographics Query ObGyn Documents Format of the Document Content and associated coded vocabulary Lab Results Document Content Format of the Document Content and associated coded vocabulary Scanned Documents Cross-Enterprise User Assertion Format of the Document Content and associated coded vocabulary Patient Identifier Cross-referencing Imaging Information Format of the Document Content Provides Trusted Identity Medical Summary (Meds, Allergies, Pbs) Format of the Document Content and associated coded vocabulary Map patient identifiers across independent identification domains Document Digital Signature Format of the Document Content and associated coded vocabulary Attesting “true-copy and origin Cross-Enterprise Document Sharing Audit Trail & Node Authentication Request Formfor Data Capture Registration, distribution and access across health enterprises of clinical documents forming a longitudinal record Centralized privacy audit trail and node to node authentication to create a secured domain. External form with custom import/export scripting Document Subscription and Notification Cross-Enterprise Document Pt-Pt Reliable Interchange Consistent Time Coordinate time across networked systems Cross-Enterprise Document Media Interchange Cross-Community Access Security & Privacy Clinical and PHR Content Patient ID Mgmt Health Data Exchange Other Trial Implementation Final Text Approved

10. Cross-Enterprise Document Sharing (XDS.b) Actor/Transaction Diagram

11. XDS-I.b Actors and Transactions Same XDS Infrastructure (Registry and Repositories) for medical summaries and imaging information !

12. Linking Report to Prior Images and Prior Report SubmissionSet 3 SubmissionSet 1 SubmissionSet 2 SubmissionSet 4 DocumentEntry DocumentEntry DocumentEntry Prior Study Manifest Prior Report Report Study Manifest Document Registry DocumentEntry Document Repository

13. Cross-Enterprise Document Sharing GP 2 Practice Repository Data Centre Shared Storage Services Enterprise Practice GP 1 Cross-Enterprise Document Registry (XDS) Imaging Center Enterprise Hospital A Repository Repository Enterprise Emergency Room Hospital B Patient Admin

14. Electronic Images Sharing beyond ….. Cross-Community Image Exchange

15. Cross-Community Access of Images (XCA-I) the next Sea change Foundational with Standards incl. DICOM Web services • DICOM WADO-WS supp-148) Interoperable with clinical portals • Compatible with IHE Web services profiles, including Security and privacy Interoperable with PACs and vendor neutral archives • Ready for cloud hosted apps

16. Why extend XDS? • XDS only addresses document sharing within an XDS Affinity Domain • Cross-Community addresses the questions: • How to share documents between XDS Affinity Domains? • How to share documents with non-XDS Affinity Domains?

17. XCA Transaction Diagramminimum required

18. XCA Transaction Diagram

19. XCA-I Transaction Diagram

20. XCA-I Foundational with Standards incl. DICOM Webservices DICOM WADO-WS supp-148) Interoperable with clinical portals Compatible with XDS.b, XUA, ATNA Interoperable with PACs and vendor neutral archives Compatible with XDS-I.b, DICOM-WS Ready for cloud hosted apps

21. Imaging Object Change Management (IOCM) IOCM specifies how to communicate changes applied on existing imaging objects to other systems. Changes include • rejection due to quality or patient safety reasons, • correction of incorrect modality worklist entry selection, • expiration due to data retention requirements. IOCM is fully compatible with existing profiles!

22. Providers and Vendors Working Together to Deliver Interoperable Health Information Systems in the Enterprise and Across Care Settings http://www.ihe.net http://www.ihe.net.au