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DICOM Anniversary Conference, Monday, September 22, 2003, 1:30 p.m. The History and Future of DICOM and HL7

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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. DICOM Anniversary Conference, Monday, September 22, 2003, 1:30 p.m. The History and Future of DICOM and HL7. 1..1 1..1.

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Presentation Transcript
slide1
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

DICOM Anniversary Conference, Monday, September 22, 2003, 1:30 p.m.The History and Future ofDICOM and HL7

1..1 1..1

LAItechnology

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

Today’s talk
diagnostic imaging in the patient care process
Diagnostic Imaging in the Patient Care Process

Hospital Enterprise

Exam

context

Radiology

diagnostic imaging in the patient care process1
Diagnostic Imaging in the Patient Care Process

Hospital Enterprise

Exam

context

Results,

Images

Radiology

diagnostic imaging in the patient care process2
Diagnostic Imaging in the Patient Care Process

Hospital Enterprise

Exam

context

Results,

Images

Radiology

$, £, ¥, etc.

scope of standards
Scope of Standards

Scope ofHL7

Medical Informatics

. . .

PatientBedsideMonitoring

Administrative HIS/RIS

Lab Data

. . .

DiagnosticImaging

Scope ofDICOM

origins
Origins

ANSI HISPP

SCAMC (AMIA) Harmonization Sessions

HL7

ANSI JWGDIC

ACR/NEMA

ISIS

HISPP MSDS

CEN TC251

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)

DICOM-HL7 relationship
slide10
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

HL7

2119 voting members(Nov. 2001)

slide11
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

HL7
slide12

DICOM

HL7

Board ofDirectors

DSC

1

1

Work items

TSC

1

1

Charters

1

n

WG6

Ballots

TCs

Ballots

1

n

1

n

WGxx

SIGs

slide13

DICOM

HL7

Board ofDirectors

Policy

DSC

1

1

Work items,

Policy

TSC

1

1

Charters

1

n

WG6

Ballots

TCs

Ballots

WG20

WGxx

. . .

IISIG

. . .

SIGs

iisig wg20 work areas
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
hl7 version 3
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
slide20

Patient& visit

Study &acquisition

Storeddata

slide21

Patient& visitIODs

Study &acquisitionIODs

StoreddataIODs

slide22

Message

Message

Message

Message

Message

Message

Message

Message

slide23

Entity

Role

Participation

Act

Document Structures

Message Control

imaging order r mim
Imaging Order R-MIM

Act

Participation

Role CMET (Common Message Element Type)

Act Relationship

Entity

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

The HL7 Clinical Document Architecture (CDA)
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

HL7 Clinical Document Architecture (CDA)
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

HL7 Clinical Document Architecture (CDA) Release 2
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

Release 2 CDA
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)

CDA Implementations
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

HL7 Templates
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

A Number of Connections
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

More Connections
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

A Rewarding Partnership