Management of Radiology Report Templates - Detailed Proposal

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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

The variability in radiology report structure, content and terminology makes reports difficult to process and can cause communication errors. In response to these shortcomings, RSNA has created a library of best-practices report templates that will contain over 100 templates by the end of 2010. Managing and distributing templates based on standard ontologies would promote convergence among radiology practices, but the relevant systems are not available to support and encourage the use of consistent report templates.

A new Management of Report Templates (MRT) profile could describe mechanisms for templates to be queried, pulled or pushed to relevant systems, enabling transfer between reporting systems, and fostering the use of standard templates from template libraries created by radiology practices, professional organizations, and vendors.

Individuals from RSNA Reporting Committee are prepared to participate in Profile development.

2. The Problem

Radiology reports today display significant variation in structure, content and terminology. Referring clinicians find it much more difficult to find the information they need in reports that vary significantly in content and structure, hampering communications and creating risk of 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.

In 2007, the ACR Intersociety Summer Conference reached consensus that a structured and standardized reporting method was optimal, provided that automated reporting tools become available to create reports efficiently. The conference group also recommended that professional societies begin developing a set of best-practices report templates.

In 2008, the RSNA convened the Reporting Committee, chaired by Drs. Langlotz and Kahn, to create a set of report templates. An initial community forum was held to select technical standard and to develop a set of standard report headings. Thirtenn subcommittees of clinical experts were convened and have created 70 report templates. The committee expects more than 100 templates to be available at the time of the 2010 RSNA annual meeting.

These templates are available on the RSNA web site, and many institutions have created their own large libraries of templates. Some vendors provide libraries of templates as well. However, there are no reliable vendor-independent methods to exchange templates among individuals, systems, and organizations. This creates an inefficient market for reporting systems, since customers must consider the substantial cost of migrating templates between potentially incompatible proprietary vendor template formats.

Standardized templates such as those recently developed by RSNA, would make reports clearer and easier to consume quickly, resulting in better speed and quality of care. A profile to manage and exchange report templates will result in wider dissemination of best-practices, will improve the quality of radiology communication, and will reduce the risk of errors. The increased use of underlying ontologies will facilitate machine processing of report information, enabling decision support, integration with other elements of the electronic medical record, and improved quality of care.

3. Key Use Cases

Report Template Single Download/Upload

A radiologist is using a vendor-supplied reporting system, such as a speech recognition 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 systems and structured reporting systems
  • RIS / PACS / EMRs

Relevant Standards:

  • RadLex
  • HL7
  • XML (RelaxNG), CDA
  • DICOM Hanging Protocols (selection model)
  • IHE ITI Profile: Shared Value Sets (SVS)
  • IHE QRPH Profile: RPE (Retrieve Protocol for Execution)?

5. Technical Approach

The RSNA templates have been encoded in RelaxNG, a schema language for XML. Reports contain text and "fields", which can be filled in by a set of choices. Any part of the report can refer back to a term from a standard terminology or ontology. To date, most of the references are to RadLex. A semi-automated terminology mapping tool has already been developed. The RelaxNG templates have been developed so that they can produce a report that can serve as a CDA document.

The profile will provide a method to convey templates and their embedded terminology information to multiple report creation systems.

The format of the resulting report will be determined by the report system that utilizes the template, but template may specify some behaviors of the report creation system during report creation (i.e. what it's required to do in response to "instructions" in the templates).

Existing actors

  • Report Creator, Report Manager? Image Manager/Archive?
  • Value Set Repository, Value Set Consumer

New actors

  • Template Manager

Existing transactions

Consider use of the SVS transactions for distributing terminologies.

New transactions (standards used)

Based on the selected distribution model (see below) will need corresponding transactions.

  • A semi-automatic query/selection method similar to DICOM Hanging Protocols might be useful

Impact on existing integration profiles

  • Might result in changes to SVS if gaps are found
  • Might affect Reporting Workflow (but more likely just flagged as a synergy)

New integration profiles needed

  • Mostly this is about a new profile for Management of Reporting Templates (MRT)

Breakdown of tasks that need to be accomplished

  • decide on distribution model (query/retrieve, publish/subscribe, simple push, simple load)
  • decide on packaging for templates (CDA, SR, XML Doc, etc.)
  • use/adapt SVS transactions for terminology
  • draft transactions for template transport

6. Support & Resources

  • The RSNA Reporting Committee and its subcommittees are committed to working with the IHE and DICOM WG8 to create a template exchange profile. Representatives have been integrally involved in drafting the proposal and attended the 10/22 review teleconference to describe the proposal.
  • The RSNA RadLex Committees have been responsive to requests for new terms that have been needed to create new report templates, and view the structured reporting effort as a primary showcase for the clinical deployment of their ontology development work.
  • At least one reporting vendor has already encoded many of the RSNA templates in their system.
  • RSNA will continue to encourage vendor involvement and support and intends to hold a second radiology reporting forum in spring 2011.

7. Risks

  • Might not be able to get the reporting workstation vendors to participate/implement
    • Initial interest from ...
    • RSNA is engaging with reporting vendors


8. Open Issues

  • Is this a radiology profile or should it be handled in PCC or ITI?
    • Probably Radiology. Radiology is uniquely and solely focused on the creation of reports from diagnostic images. The vendors involved, the workflows involved, and many of the concepts are Radiology specific, but it likely has good overlap with the image report creation activities in Cardiology, endoscopy, and in the future, Pathology.
    • Not clear there is a benefit to abstracting this further to "templates for any medically-related report generation", since diagnostic imaging reports have an internal structure that is significantly different than most other medical documents.
  • 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, however should probably focus on radiology to have a concrete use case and specific stakeholders.
  • Are these templates used by speech recognition as well?
    • Yes, the syntax of the RelaxNG templates are intended to be compatible with the simpler case of blanks within the macros of current speech recognition systems, and the report exchange profile should address that use case, since speech recognition systems are currently the most common type of installed reporting systems.

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
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