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: <One Of> David S. Mendelson, Curtis Langlotz, Charles Kahn
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.

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.>

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. Discussion

<Include additional discussion or consider a few details which might be useful for the detailed proposal>

<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.

Questions

Is this a radiology profile or should it be handled in PCC or ITI?
- Partly depends on how multi-purpose the reporting stations are. Probably have overlap with Cardiology and maybe Pathology