How RadLex,, RTE, MRRT, CDA, and XDS work together - White Paper

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1. Proposed Workitem: How RadLex,, RTE, MRRT, Supp 155 CDA, and XDS work together - White Paper

  • Proposal Editor: Teri Sippel Schmidt
  • Editor: Teri Sippel Schmidt (Karos), Harry Solomon-need to verify (GE), Leela Holliman (CCO), Curt Langlotz (Stanford), Chuck Kahn (UPenn)
  • Date: N/A (Wiki keeps history)
  • Version: N/A (Wiki keeps history)
  • Domain: Radiology

2. The Problem

There has been a significant amount work done in the area of structured reporting and coding and report templates done in recent years. This includes:

  • additions to RadLex to include new attributes
  • almost 300 radiology report templates in with almost 1.5 million downloads
  • the creation of a new Report Template Editor/Creator app for RSNA
  • the IHE Management of Radiology Report Templates (MRRT) supplement
  • the DICOM Supplement 155 - Imaging Report Template in HL7 CDA format
  • and exporting CDAs to the enterprise using XDS (change proposals to XDS and XDS-I)

All of these initiatives are intended to work harmoniously. For radiologists or IT staff who are not directly involved in DICOM, HL7, and IHE, however, it can be overwhelming and may not be immediately obvious why all of these pieces are necessary, how they fit together, or what the intended benefits are.

Value Statement:

This white paper, similar to the IHE Code Mapping White Paper, would perform two primary functions:

  • describe how the pieces work together
  • describe the clinical, administrative and research benefits which can be gained by implementing and

utilizing fully structured and coded reports, both for primary and secondary uses of report data

NOTE: this is not intended to take the place of an IHE Rad Content Profile for Imaging Reports. Rather, as DICOM Supp 155 completes public comment and is approved, this Content Profile will be proposed for the 2015-2016 IHE cycle.

3. Key Use Case

The key use case would be the straight forward path:

  • Patient enter ER with shortness of breath. Pulmonary embolism is suspected.
  • An order is created. The identifying info from the order is accurately mapped using SWF (in RAD TF-2).
  • CT lung study is performed.
  • Radiologist decides to check for best practice template on
  • Best practice template has been created and reviewed by a group of experts using the Report Template Editor and stored in MRRT format.
  • The radiologist chooses to download this template to the local reporting system.
  • Two actionable findings (previously known as "Critical Results") are identified: Cat 1 - no PE; Cat 3 - small lung nodule
  • The actionable findings are communicated verbally and the communication is documented in the report. (probably illustrate more useful clinical applications like this)
  • The report (instance) is created and verified. The order info is accurately mapped into the CDA header. (not in RAD TF-2)
  • The report is exported to the enterprise by accurately mapping the correct identifiers from the CDA doc into the XDS metadata.

4. Standards and Systems

  • RSNA RadLex
  • RSNA
  • DICOM/HL7 Supp 155

5. Discussion

The purpose of this white paper to pull together and promote many existing and useful initiatives.

It is an attempt to take a very complex topic with many moving parts and distill it down to something which is more understandable for folks who do not live and breathe IHE and DICOM every day.