Radiology Imaging Report Content Profile - Detailed Proposal - 2012-2013

1. Proposed Workitem: Radiology Imaging Report Content Profile

Proposal Editor: Michel Pawlicz/Karos Health, Teri Sippel Schmidt/Karos Health
Editor:
Contributors: Teri Sippel Schmidt/Karos Health, Michel Pawlicz/Karos Health, Kinson Ho/Agfa Healthcare
Date: N/A (Wiki keeps history)
Version: N/A (Wiki keeps history)
Domain: Radiology

Summary

Overview: Healthcare professionals using simple information systems to access health records want access to diagnostic imaging reports.

Existing Problem: Currently there is no unified standard-based format defined and implemented to access imaging reports from simple EMR applications.

Key Integration Feature/Problem Solved: We propose to create a new content profile to define the diagnostic imaging report based on HL7 CDA, leveraging the work done in other IHE domains (e.g. PCC), SDOs (DICOM WG 8) and collaborative working groups (HL7 IG CDA-DIR).

Market Interest Canada, UK and Denmark among others have adopted HL7 CDA as the document content format to standardize DI Reports and have started to document and provide guidance for implementing DI Reports based on CDA.

Key Benefits As the countries and jurisdictions move forward with their EMR programs the distribution of hospital reports, including DI reports, is seen as a key benefit of EHR-EMR interoperability to providers. As such, they are looking for guidance on the use of standards for access to DI reports. DI reports fall into the wider universe of clinical documents including discharge summaries, care summaries and referral notes, which follow common workflow patterns when viewed from the perspective of a primary care provider.

2. The Problem

In many countries and jurisdictions efforts are underway to exchange imaging data across healthcare enterprises using XDS. While initially the focus of these exchanges was on achieving filmlessness, for example in Canada, the need to distribute Diagnostic Imaging (DI) results to primary care physicians is only now becoming a requirement.

In Canada, one of the key goals of the Infoway DI Program is to provide access to imaging health records to authorized care providers from anywhere and anytime regardless where the images were acquired and reports created. This includes access from simple EMR applications used at the physician offices and clinics. Access to imaging health records and in particular the DI report must be provided using standard-based protocols to facilitate EHR-EMR interoperability. However, there is no standard-based protocol defined and implemented to access imaging reports from the EMR applications.

As the countries and jurisdictions move forward with their EMR programs the distribution of hospital reports, including DI reports, is seen as a key benefit of EHR-EMR interoperability to providers. As such, they are looking for guidance on the use of standards for access to DI reports. DI reports fall into the wider universe of clinical documents including discharge summaries, care summaries and referral notes, which follow common workflow patterns when viewed from the perspective of a primary care provider.

Existing content formats used in Radiology such as DICOM SR fail to satisfy the requirements of access by simple EMRs used by primary care physicians. In addition, adoption and consistent use of DICOM SR by Radiology vendors is lacking providing significant practical implementation challenges. Alternatively PDF could be used but this doesn't leave the opportunity for structured content and future alignment with lexicon, terminology standards and report templates based on the work done by RSNA. For these reasons HL7 CDA has been chosen by Canada, Denmark and UK and is proposed as the document content format for this proposed content profile.

The proposed content profile leans on effort underway as part of Canada Health Infoway's Standard Collaborative Working Group 10 (Diagnostic Imaging). Aligning this work with other national initiatives in the UK and Denmark, among others, by IHE Radiology saves effort and improves overall coordination and guidance. Ultimately leading to better and consistent exchange and access to DI Reports.

The scope for the coming year might only be on providing the content for the header and common body and a template for basic/common DI report, however future work might include alignment with the reporting effort underway by RSNA (Report Templates) and work of DICOM WG 8. Future effort will also ensure proper specifications of mappings for RadLex codes, although the use of RadLex codes will remain optional.

A lot of effort/work has been done by other domains that should be leveraged. Additionally, because over 35 CDA-based content modules have already been tested at the Connectathons, it is hoped that the adoption rate for this profile at the North American Connectathon in January of 2014 will be very high.

3. Key Use Case

DI reports fall into the wider universe of clinical documents including discharge summaries, care summaries and referral notes, which follow common workflow patterns when viewed from the perspective of a primary care provider. Users, in particular primary care physicians, want access to DI Reports from within their EMRs regardless where the images were acquired and reports created. With the emerging availability of XDS based exchange networks common and standardize access to DI Reports must be provided for. The use case for accessing DI Reports is is similar for accessing any clinical documents and results from tests that the primary care physician has requested for his/her patient. Within XDS the user is using therefor an XDS consumer to access the DI Report that displays the information in a consistent and human readable manner, regardless which application created the report or where the report was created.

Use Case 1: Primary Care Physician want access to DI Report from within their EMR, regardless of where report was created and images where acquired and read.

Use Case 2: Radiologist wants access to prior DI Reports from within the solution she/he is using to diagnose images. DI Report may contain links to (key) images.

Use Case 3: Clinicians, health care professionals in general want access to medical history from within the EHR/EMR including the DI reports for the patients they are providing care to.

4. Standards and Systems

Systems:

Department System Scheduler/Order Filler (DSS/OF)
PACS
Reporting system
EMR
EHR Viewers / Content Consumers

Standards:

Terminology / Lexicons: SNOMED CT, RadLex
IHE Radiology Scheduled Workflow
tangentially XDS/XDS-I
Other IHE content profiles (PCC XDS-MS, CAR CIRC)
HL7 CDA Release 2
HL7 Consolidated CDA
HL7 Implementation Guide (IG) CDA R2 Imaging Integration - Basic Imaging Reports in CDA and DICOM Diagnostic Imaging Reports (DIR)
DICOM SR to CDA Transformation Guide (DICOM Supplement 135)

5. Technical Approach

Existing actors

As this is planned to be a content profile we use the existing Content Creator and Content Consumer actors in this context; rather, a new "Radiology Report" content module will be created.

New actors

No new actors are required.

Existing transactions

Existing transactions as defined by XDS, XDS-I, XDR, XDR-I, and XDM.

New transactions (standards used)

No new transactions are required.

Impact on existing integration profiles

No impact on existing integration profiles is expected.

New integration profiles needed

A new content module profile is needed.

Breakdown of tasks that need to be accomplished

Review current work/status of DICOM WG 8 to verify that there is no overlap.
Determine short term (without structured report templates, focusing initially on basic XDS interchange) or long term (with templates) approach for first version of profile.
Review and align with Consolidated CDA Header publication.
Review existing IHE PCC and Cardiology content modules as examples.
Map key diagnostic (DI) report elements into CDA header. Leverage HL7 IG CDA R2 Imaging Integration and DICOM Suppl 135.
Write up supplement template based on IHE content profile template.

6. Support & Resources

Canada Health Infoway is a key driver for this profile, at least in terms of schedule. Karos Health resources can be applied to creating this mapping, but we will need committee review. Will work in conjunction with DICOM WG 8, if applicable.

7. Risks

This is seen as a low technical risk proposal given the number of CDA based content profiles which have already been implemented and tested at the Connectathon.

Some risk associated with harmonizing Canadian proposals with Consolidated CDA/XD*

Some risk associated with further expansion of the "allowed" formats for Rad reports. Convergence/reduction at some point is desirable.

8. Open Issues

Determine overlap (or not) with DICOM WG 8 efforts.
Determine if scope includes radiology structured templates (RSNA structured templates) or just undefined DI content.
Which Supplement Template to use?
A content profile is in principle transport neutral. This proposal may require an enhancement to XDS-I to support storing of the original CDA rather then using XDS-SD because XDS-SD wraps anything in a base64 encoded blob, even though the blob itself may be text (i.e. CDA). We currently consider transport outside the scope of this proposal. Required changes to XDS-I as a result of this proposal might need be considered for a CP.
Determine relationship/mapping/parallelism with SINR Profile (content, transport, report states, dept & enterprise access)

9. Tech Cmte Evaluation

Effort Evaluation (as a % of Tech Cmte Bandwidth):

25% to work up a CDA-based payload for
40% if we also address paralleling/mapping SINR and CDA+XDS

Responses to Issues:

See italics in Risk and Open Issue sections

Candidate Editor:

Teri or Kinson