Management of Radiology Report Templates - Detailed Proposal

1. Proposed Workitem: Management of Radiology Report Templates

• Proposal Editor: David S. Mendelson, Curtis Langlotz, Charles Kahn
• Editor: <One Of> David S. Mendelson, Curtis Langlotz, Charles Kahn
• Domain: Radiology

Summary

<Summarize in a few lines the existing problem . E.g. "It is difficult to monitor radiation dose for individual patients and almost impossible to assemble and compare such statistics for a site or a population.">

<Demonstrate in a line or two that the key integration features are available in existing standards. E.g. "DICOM has an SR format for radiation dose events and a protocol for exchanging them.">

<Summarize in a few lines how the problem could be solved. E.g. "A Radiation Dose profile could require compliant radiating devices to produce such reports and could define transactions to actors that collect, analyze and present such information.">

<Summarize in a line or two market interest & available resources. E.g. "Euratom and ACR have published guidelines requiring/encouraging dose tracking. Individuals from SFR are willing to participate in Profile development.">

<Summarize in a line or two why IHE would be a good venue to solve the problem. E.g. "The main challenges are dealing with the chicken-and-egg problem and avoiding inconsistent implementations.">

2. The Problem

<Summarize the integration problem. What doesn’t work, or what needs to work.>

Radiology reports today display significant variation in structure, content and terminology.

Referring physicians find this variation means assimilating the content of the reports is slower/harder/more prone to misunderstandings.

The variability also makes it difficult for machines to accurately extract facts from the report, making it extremely difficult to provide decision support, data mining or fully integrated electronic medical records.

Standard report templates and ontologies are one way to address this problem, however they cannot currently be reliably distributed, updated and incorporated into the systems that generate and consume electronic reports.

<Now describe the Value Statement: what is the underlying cost incurred by the problem, what is to be gained by solving it>

Standardized templates and ontologies, such as those recently developed by RadLex, would make reports clearer/faster to understand, resulting in better speed and quality of care; and would facilitate machine processing, decision support and record integration, also resulting in improved quality of care.

A profile to manage these templates and ontologies would speed adoption in products and by users.

3. Key Use Case

<Describe a short use case scenario from the user perspective. The use case should demonstrate the integration/workflow problem.>

<Feel free to add a second use case scenario demonstrating how it “should” work. Try to indicate the people/systems, the tasks they are doing, the information they need, and hopefully where the information should come from.>

Report Template Single Download/Upload

A radiologist is using a vendor-supplied reporting system in the reading room to report an exam type for which he has not yet created a satisfactory template.

• Rad browses the RSNA or other template library to find a template that would be ideal for the exam being reported.
• Rad clicks the “Download Template” button and saves the template as a file on his desktop.
• Rad selects “Upload Template” in the reporting software, selects the file on his desktop
• Reporting software imports the template and adds it to the template/macro list
• Rad optionally edits the template using the reporting system tools
• Rad selects the template and proceeds with report.

Report Template Bulk Download/Upload A vendor is installing a new reporting system at an institution that would like to go live with a significant portion of RSNA or other radiology template library ready for use. A radiologist from that institution browses the RSNA template library, selecting the templates he would like to be available at go live, and downloads them as a single file containing multiple templates. That file is uploaded to a particular user or group profile in the reporting system, where all of the templates are available for use by the radiologist.

Report Template Data Migration An institution is changing speech recognition vendors, but would like to retain the templates that the radiologists have been using in the old system, which have been refined over many years of use. The informatics staff use the “Export Templates” function on the old system to create an export file containing all of the templates in the old system, organized by group and user profile. An “Import Templates” function on the new system is then used to make those same templates available in the corresponding profiles in the new reporting system.

4. Standards & Systems

Systems involved:

• Voice/Speech recognition transcription systems / RIS /PACS /EMRs

Relevant Standards:

• RadLex
• HL7
• XML (RelaxNG), CDA

• IHE ITI Profile: Shared Value Sets (SVS)
• IHE QRPH Profile: RPE (Retrieve Protocol for Execution)?

5. Technical Approach

<This section can be very short but include as much detail as you like especially if you have some ideas. The Technical Committee will flesh it out when doing the effort estimation.>

<Outline how the standards could be used/refined to solve the problems in the Use Cases. The Technical Committee will be responsible for the full design and may choose to take a different approach, but a sample design is a good indication of feasibility.>

<If a phased approach would make sense indicate some logical phases. This may be because standards are evolving, because the problem is too big to solve at once, or because there are unknowns that won’t be resolved soon.>

Existing actors

<Indicate what existing actors could be used or might be affected by the profile.>

New actors

<List possible new actors>

Existing transactions

<Indicate how existing transactions might be used or might need to be extended.>

New transactions (standards used)

<Describe possible new transactions (indicating what standards would likely be used for each. Transaction diagrams are very helpful here. Feel free to go into as much detail as seems useful.>

Impact on existing integration profiles

<Indicate how existing profiles might need to be modified.>

New integration profiles needed

<Indicate what new profile(s) might need to be created.>

Breakdown of tasks that need to be accomplished

<A list of tasks would be helpful for the technical committee who will have to estimate the effort required to design, review and implement the profile.>

6. Support & Resources

<List groups that have expressed support for the proposal and resources that would be available to accomplish the tasks listed above.>

7. Risks

<List technical or political risks that will need to be considered to successfully field the profile.>

8. Open Issues

<Point out any key issues or design problems. This will be helpful for estimating the amount of work and demonstrates thought has already gone into the candidate profile.>

• Is this a radiology profile or should it be handled in PCC or ITI?
  • Probably Radiology. The work this is being based on, the vendors involved, the workflows involved and many of the concepts are Radiology specific, but it likely has good overlap with Cardiology and maybe Pathology (i.e. image-based, diagnostic focus).
  • Not clear there is a benefit to abstracting this further to "templates for any medically-related report generation"

• Should the scope be expanded to care plans or limited to report templates
  • In theory we could develop a general purpose template distributor rather than a radiology reporting specific solution.

• Are these templates used by Voice Rec as well?
  • Yes, potentially.
  • Should consider the syntax for dealing with blanks etc, to be acceptable to the various voice rec companies.

9. Tech Cmte Evaluation

<The technical committee will use this area to record details of the effort estimation, etc.>

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

• 35% for ...

Responses to Issues:

See italics in Risk and Open Issue sections

Candidate Editor:

TBA