Difference between revisions of "Management of Radiology Report Templates - Brief Proposal"

Latest revision as of 10:40, 5 October 2012

1. Proposed Workitem: Management of Radiology Report Templates

Proposal Editor: David S. Mendelson, Curtis Langlotz, Charles Kahn
Editor: Curtis Langlotz
Domain: Radiology

2. The Problem

Radiology reports today display significant variation in structure, content and terminology. There is a rapidly growing consensus among radiologists that template-based radiology reporting is the optimal method to create imaging reports. Radiology practices are looking for reporting products that incorporate advanced template functionality, enable rapid editing and adoption of templates, and provide a means for template distribution and data migration among vendor systems.

To support this growing trend, the RSNA reporting initiative has produced nearly 200 standard templates, indexed by standard terminology, over the past 3 years, and recently established a template exchange site where radiologists and others could upload their own templates for others to adopt. DICOM WG8 has begun work on a supplement to describe standards for the representation of report instances that would be created from radiology report templates.

Standardized templates improve communication, and make reports easier to understand and quicker to read, improving the quality and safety of care delivery. For these reasons, standardized reports are overwhelmingly preferred by referring clinicians. Discrete terminology and other metadata associated with templates, and the report instances they produce, facilitates machine processing, decision support and record integration, also improving quality of care.

A profile to manage these templates would accelerate the adoption of key template features in products and thereby accelerate the adoption of templated reporting by radiologists and others.

3. Key Use Cases

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:

Speech recognition and structure reporting systems / RIS systems / PACS systems

Relevant Standards:

Terminology: RadLex, LOINC, SNOMED
Template format: defined by profile, based on XML
Report instance format: defined by DICOM WG8, likely based on HL7 CDA

5. Discussion

Over the past 2 years, with active participation of reporting system vendors and clinical radiologists, the IHE has produced a white paper that describes an information model and format for the representation and exchange of radiology templates and the fields they contain. The completed MRRT white paper was submitted for public comment earlier this week. The purpose of this brief proposal is to gain approval for the additional work necessary to convert this white paper into a formal IHE profile, and to create template samples that could be used with this profile as part of the IHE connect-a-thon process.

Image reporting is a workflow issue that is a natural extension of other IHE work. While many IHE profiles touch on the workflow surrounding the generation and storage of images, this missing piece involves integrating the generation and sharing of reports and the subsequent use of coded report content.

Key open issues that would need to be resolved over the coming year are as follows (taken from the open issues list of the white paper):

Harmonizing this framework for templates with the framework for report instances under discussion by DICOM WG8
Modifying existing RSNA templates to conform to the IHE framework (performed by RSNA)
Finalizing the scope for field identifiers for reports in which more than one template has been invoked
Formalizing semantics of inheritance among templates
Creating coded entry examples of both in-line markup and markup in a separate section
Providing more specific guidance on how merge fields should be specified and retrieved using coded content
Exploring more flexible methods for representation of coded content

@@ Line 5: / Line 5: @@
 * Proposal Editor: David S. Mendelson, Curtis Langlotz, Charles Kahn
-* Editor: <One Of> David S. Mendelson, Curtis Langlotz, Charles Kahn
+* Editor: Curtis Langlotz
 * Domain: Radiology
 ==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.  There is a rapidly growing consensus among radiologists that template-based radiology reporting is the optimal method to create imaging reports.  Radiology practices are looking for reporting products that incorporate advanced template functionality, enable rapid editing and adoption of templates, and provide a means for template distribution and data migration among vendor systems.
-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.
+To support this growing trend, the [http://www.rsna.org/Reporting_Initiative.aspx RSNA reporting initiative] has produced [http://radreport.org/ nearly 200 standard templates], indexed by standard terminology, over the past 3 years, and recently established a template exchange site where radiologists and others could upload their own templates for others to adopt.  DICOM WG8 has begun work on a supplement to describe standards for the representation of report instances that would be created from radiology report templates.
+Standardized templates improve communication, and make reports easier to understand and quicker to read, improving the quality and safety of care delivery.  For these reasons, standardized reports are overwhelmingly preferred by referring clinicians.  Discrete terminology and other metadata associated with templates, and the report instances they produce, facilitates machine processing, decision support and record integration, also improving quality of care.
-''<Now describe the Value Statement: what is the underlying cost incurred by the problem, what is to be gained by solving it>''
+A profile to manage these templates would accelerate the adoption of key template features in products and thereby accelerate the adoption of templated reporting by radiologists and others.
-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.
+==3. Key Use Cases==
-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'''
@@ Line 50: / Line 35: @@
 '''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
+* Speech recognition and structure reporting systems / RIS systems / PACS systems
 Relevant Standards:
-* RadLex
+* Terminology: RadLex, LOINC, SNOMED
-* HL7
+* Template format: defined by profile, based on XML
-* XML, CDA
+* Report instance format: defined by DICOM WG8, likely based on HL7 CDA
-* ?IHE RPE (Retrieve Protocol for Execution)?
 ==5. Discussion==
-''<Include additional discussion or consider a few details which might be useful for the detailed proposal>''
+Over the past 2 years, with active participation of reporting system vendors and clinical radiologists, the IHE has produced a white paper that describes an information model and format for the representation and exchange of radiology templates and the fields they contain.  The [ftp://ftp.ihe.net/Radiology/iherad-2012/Tech_Cmte/Supp%20Development/IHE_RAD_Whitepaper-RadiologyReportTemplates_2012_10_03.doc completed MRRT white paper] was submitted for public comment earlier this week.  The purpose of this brief proposal is to gain approval for the additional work necessary to convert this white paper into a formal IHE profile, and to create template samples that could be used with this profile as part of the IHE connect-a-thon process.
-:''<Why IHE would be a good venue to solve the problem and what you think IHE should do to solve it.>''
-:''<What might the IHE technical approach be? Existing Actors? New Transactions? Additional Profiles?>''
-:''<What are some of the risks or open issues to be addressed?>''
-This is a workflow issue which is a continuation of much of the existing IHE profiles.  While many of the profiles touch on the workflow surrounding generating and storing images this missing piece involves integrating the generation and sharing of reports and use of report content.  This profile would start to close that gap.
+Image reporting is a workflow issue that is a natural extension of other IHE work.  While many IHE profiles touch on the workflow surrounding the generation and storage of images, this missing piece involves integrating the generation and sharing of reports and the subsequent use of coded report content.
+Key open issues that would need to be resolved over the coming year are as follows (taken from the open issues list of the white paper):
+* Harmonizing this framework for templates with the framework for report instances under discussion by DICOM WG8
+* Modifying existing RSNA templates to conform to the IHE framework (performed by RSNA)
+* Finalizing the scope for field identifiers for reports in which more than one template has been invoked
+* Formalizing semantics of inheritance among templates
+* Creating coded entry examples of both in-line markup and markup in a separate section
+* Providing more specific guidance on how merge fields should be specified and retrieved using coded content
+* Exploring more flexible methods for representation of coded content