Management of Radiology Report Templates - Brief Proposal

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