The History and Future of DICOM and HL7

DICOM Anniversary Conference, Monday, September 22, 2003, 1:30 p.m The History and Future of DICOM and HL7 1 1 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 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 Diagnostic Imaging in the Patient Care Process Hospital Enterprise Exam context Radiology Diagnostic Imaging in the Patient Care Process Hospital Enterprise Exam context Results, Images Radiology Diagnostic Imaging in the Patient Care Process Hospital Enterprise Exam context Results, Images Radiology $, £, ¥, etc Sco pe of Stan dar ds Medical Informatics Patient Bedside Monitoring Scope of HL7 Administrative Lab Data HIS/RIS Diagnostic Imaging Scope of DICOM Disagreements in Healthcare Origins ANSI HISPP HL7 ANSI JWGDIC ACR/NEMA HISPP MSDS SCAMC (AMIA) Harmonization Sessions CEN TC251 ISIS 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) HL7 • ANSI-accredited standards development organization, formed in 1987 • 16+ year old membership organization – 512 organizations 2119 voting members – 862 individual members (Nov 2001) • 14 Technical Committees (TCs) • 17 Special Interest Groups (SIGs) • 22 international affiliates • A week of working group meetings times annually, about 400 people attending more than 25 parallel sessions and tutorials Communication dog Patient Patient & visit makes Study Content Notification has 1-n 1-n Visit describes 1 includes 1-n Study 1-n Comprised of 1-n Comprised of 1-n Study Components Study & acquisition Modality Performed Procedure Steps 1 includes includes 1-n 1-n contains See Note 1-n 1-n 0-n Results 0-1 Frame of Reference 1-n Spatially Defines contains 1-n creates Equipment 0-1 Series Report contains Stored data 0-n 0-n Stored Print 0-n Radiotherapy Objects 0-n Curve 0-n Lookup Table Image 0-n Overlay 0-n Ammendment Patient IOD Patient & visit IODs 1 references Basic Study Descriptor IOD references 1-n 1-n Visit IOD describes 1 references 1-n Study IOD 1-n Comprised of 1-n Comprised of Study & acquisition IODs 1-n Study Component IOD Modality Performed Proc Step IOD 1 references references 1-n references See Note 0-n Results IOD Stored data IODs 0-n 0-n Stored Print IOD See Figure 7.2b 0-n Radiotherapy IODs See Figure 7.2c Standalone Modality LUT IOD 0-n Standalone VOI LUT IOD 0-n references Standalone Curve IOD 0-n Standalone Overlay IOD 0-n Image IOD 0-1 Interpretation IOD Message e es M sa ge es M g sa Message Message es M sa e M ge Message ag s s e Entity Role Entity Language_comm unication language_cd : CE preference_ind : BL mode_c d : CV proficiency_level _cd : CV id : SET class_cd : CS determiner_cd : CS importance_status _txt : ED used_by pla ys clas s_cd : CS effective_time : IVL id : SET s tatus_cd : CS position_nbr : LIST qty : RTO certificate_txt : ED addr : SET telecom : SET cd : CE * sends shall_receive 1 telecom : SET des c : ED status_cd : CS cd : CE nm : SET risk_cd : CE handling_cd : CE scopes is_scoped_by * i s_source_f or has_source effective_time : IVL * type_cd : CS is_target_for has_target has_as_parti cipant participates_i n Act type_ cd : CS time : IVL note_txt : ED signature_cd : CV functi on_cd : CD awarenes s_ cd : CV signature_txt : ED encounter_a ccom mod ation_cd : CV status_cd : CS m ode_cd : CV seq uence_n br : INT Act_relationship id : SET mood_cd : CS class_cd : CS txt : ED status_cd : CS has activity_time : GTS effective_tim e : GTS confidentiality_cd : SET repeat_nbr : IVL interruptible_ind : BL priority_cd : SET independent_ind : BL availability_time : TS cd : CD * reason_cd : CV origi nates_in_context_of status_time : TS for * * 1 * Act Participation * Relationship_link Role played_by communicates_with qty : SET * Participation type_cd : CS inversion_ind : BL sequence_nbr : INT priority_nbr : INT pause_qty : PQ checkpoint_cd : CS split_cd : CS join_cd : CS has_target negation_ind : BL conjunction_cd : CS is_source_for has_source * is_target_for * Certified_practitioner Living_subject birth_ti me : TS deceased_ti me : TS deceased_ind : BL admi nis trative _gender_cd : CE organ_do nor_ind : BL m ul tipl e_bi rth_i nd : BL birth_order_nbr : INT Entity_heir Role_heir gps _txt : ST pos ition_txt : ED addr : AD directions_txt : ED mobile_ind : BL form_cd : CV effective_tim e : IVL prov ides_context_f or Act_context Guarantor Patient credit_rating_cd : CV Person Device handicap_cd : CV s tudent_ind : BL discharge_disposition_cd : CV acuity_level_cd : CV birth_encounter_ind : BL status_reas on_cd : CV valuables _des c : ED pre_adm it_test_ind : BL referral_s ource_cd : CV special_courtesies_cd : CV valuables _location_des c : ED adm iss ion_source_cd : CV accident_cd : CV urgency_cd : CV Container capacity_qty : PQ height_qty : PQ diam eter_qty : PQ barrier_delta_qty : PQ bottom_delta_qty : PQ separator_type_cd : CD cap_type_cd : CD Financial_contract Supply Observation Employee Referral Working_list authorized_visits _qty : R EAL des c : ED reason_txt : ED owners hip_level_cd : CV Di et energy_qty : PQ carbohydrate_qty : PQ route_cd : CD dose_qty : IVL rate_qty : IVL dose_check_qty : SET m ax_dos e_qty : SET approach_site_cd : SET s ubstitution_cd : CV Transportation Device_task i s_communicated_as Inpatient_encounter Imaging_modality pixel_padding_qty : PQ pixel_intensity_relationship_cd : CV s pacial_resolution_qty : PQ Invoice_element Public_health_case detection_m ethod_cd : CE trans miss ion_mode_cd : CE disease_imported_cd : CE Diagnostic_image Context_structure local_id : ST s ubject_orientation_cd : CV c ontai ns Outbreak time : IVL Message Control Batch File_of_batch control_id : II name : ST creation_time : TS reference_control_id : II sending_application_id : II receiving_application_id : II security : ST message_count : INT batch_totals : SET batch_comment : SET contains is_contained_by h as_ re cipie nt * has_sender HEALTH LEVEL REFERENCE INFORMATION MODEL RIM_0110 Version is basis for first committee-level ballots of Version It was released July 2001, and reflects RIM changes through Harmonization on 07/20/2001 Enitites Acts (Services) * Message sending_application_id : II id : SET creation_time : TS interaction_id : II version_id : ST profile_id : SET process ing_cd : CV sequence_nbr : INT reply_to_com : TEL receiving_application_id : SET process ing_mode_cd : CV attachment_txt : ED accept_ack_cd : CV application_ack_cd : CV has occurs_with is_contained_by * c an_ac company Infrastructure (Structured documents) trol_ id : II name : ST creation _tim e : TS reference _control_id : II s end ing_ appl ica tion_id : II receiving_application_id : II contains s ecurity : ST file_batch_ count : INT file_co mment : SET Attention_line can_incl ude Query_message_interaction * Clinical_document c omp letion_cd : CV s et_id : II s torage_c d : CV vers ion_ nbr : INT c opy_ti me : TS c hange_reason _cd : CV Query key_word _txt : ST * va lue : ST me ss age_qu ery_cd : CV id : II Sort_control Infrastructure (Structured documents) Acts (Financial) Table Table_structure halign : CS char : ST charoff : ST valign : CS local_id : ST has pri ority : CV element_name : ST is_for sequence_nbr : INT * direction_cd : CV is_contained_in rules : CS cellspacing : ST cellpadding : ST summ ary : ST width : ST border : INT frame : CS in itia l_qty : PQ res ponse_modality_cd : CV return_eleme nt_g roup : SET contains Entry local_id : ST Local_attr name : ST value : ST mo dify_indicator : CV executi on_and_delivery_time : TS * is_contained_in Li nk_html title : ST name : ST href : ED rel : SET rev : SET Link Table_cell is _ackn owled ged_b y acknowledges * rowspan : INT colspan : INT abbr : ST axis : ST headers : SET scope : CS Get_more_results query_id : II quantity : INT start_result_nbr : INT Acknowledgement Roles type_cd : CV note_txt : ED error_detail_cd : CV expected_sequence_nbr : INT Query_by_parameter Infrastructure (Message control) has is_part_of has_ex pression Param eter name : ST is_for has_left_side has_right_side * Query_ack is _rhs_fo r * Logical_expression Parameter_list id : II query_s tatus_cd : CV mess age_query_cd : CV result_count_total : INT result_count_current : INT result_count_rem aining : INT * Selection_expression is_lhs_for * may_contain A_parameter value : ANY Table_column_structure span : INT width : ST Local_markup ignore_cd : CS descriptor : ST render : ST Character_data value : ST Query_by_selection is_parameter_of * Billboard produced by: Rochester Outdoor Adv ertising Account p aram eter_value : LIST message_type_id : II response_cd : CS le ngth _of_ stay_qty : PQ relational_conjunction_cd : CV Rel ational_expressi on elem ent_name : ST value : ST relational_operator_cd : CV Message Control Financial_act net_qty : MO Procedure approach_site_cd : SET method_cd : SET target_s ite_cd : SET Message_interaction hazard_ exposu re_txt : ED job_clas s_cd : C V job_titl e_nm : ST prote ctive _equipme nt_txt : ED salary_qty : MO salary_type_cd : C V job_cd : CE has_payl oad * * paym ent_terms _cd : CV Substance_administration value : ANY deri vation _expr : ST method_cd : SET targ et_s ite_cd : SET interpretation_cd : SET qty : PQ Patient_encounter Assigned_practitioner position_cd : CV primary_care_ind : BL Covered_party gauge_qty : PQ approach_site_cd : CD target_site_cd : CD Non_Person_living_subject m anufacturer_m odel_nm : ST last_cali brati on_tim e : TS s oftware _nm : ST loca l_remote_ control _state _cd : CE a lert_ level_ cd : CE fellowship_field_cd : CE residency_field_cd : CE slot_size_increment_qty : PQ Access Consent level_cd : CV lan guage_cd : CS Qualified_practitioner confidentiality_cd : CV very_important_person_cd : CV Schedul able_resource expiration_time : TS lot_nm : ST stability_time : IVL taxon omic_class ification_cd : CE breed_cd : CE s tra in_txt : ED euthana sia_ ind : BL producti on_clas s_cd : CE gen der_s tatus_cd : CE * Resource_slot slot _time : GTS Manufactured_material dis ability_cd : CE ethnic_group_cd : SET race_cd : SET ambulatory_status_cd : CV education_level_cd : CV living_arrangement_cd : CV marital_status_cd : CV religious_affiliation_cd : CV addr : SET special_accommodation_cd : SET mothers_maiden_nm : ST board_certification_type_cd : CV recertification_tim e : TS Place Material Organization standard_indus try_class_cd : CE addr : SET Document Structures item_nbr : REAL item_qualifier_cd : CE gross_qty : MO coverage_s ource_cd : CE unit_qty : RTO notify_subject_ind : BL m odifier_cd : CE factor_nbr : REAL points_nbr : REAL allowed_ balance_qty : IVL currenc y_cd : C V in teres t_rate_qty : RTO nm : ST Financial_transaction payment_terms _cd : CV debit_exchange_rate_qty : RTO credit_exchange_rate_qty : RTO interest_rate_qty : RTO Ima ging Act Ord Participationer Role CMET R(Common Message Element Type) MI M 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 body – Permits data representation at various levels of granularity – Passed first Committee ballot August 2003 – Member ballot March 2004 HL7 Clinical Document Architecture (CDA) • Level – Coded header, text content with simple formatting objects(section, paragraph, list, table) • Level – Standard codes for Level sections • Level – Full structured content derived from RIM HL7 Clinical Document Architecture (CDA) Release • Release – Coded header, text content with simple formatting objects(section, paragraph, list, table) • Release – Standard codes for Level sections – Full structured content derived from RIM Release • Release 2, Level One: CDA – 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 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) HL7 • JointTem project of Templates SIG, Structured Documents plat TC, Conformance SIG • Openestemplate registry/repository – will contain normative and non-normative templates • Tools for generating and validating templates will be developed • This will take a while 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 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 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