Radiology Imaging Report Content Profile - Brief Proposal
1. Proposed Workitem: Radiology Imaging Report Content Profile
- Proposal Editor: Michel Pawlicz / Karos Health
- Editor: Michel Pawlicz
- Date: N/A (Wiki keeps history)
- Version: N/A (Wiki keeps history)
- Domain: Radiology
2. The Problem
In many countries and jurisdictions efforts are underway to exchange imaging data across healthcare enterprises using XDS. While initially the focus of these exchanges was on achieving filmlessness, for example in Canada, the need to distribute Diagnostic Imaging (DI) results to primary care physicians is only now becoming a requirement.
In Canada, one of the key goals of the Infoway DI Program is to provide access to imaging health records to authorized care providers from anywhere and anytime regardless where the images were acquired and reports created. This includes access from simple EMR applications used at the physician offices and clinics. Access to imaging health records and in particular the DI report must be provided using standard-based protocols to facilitate EHR-EMR interoperability. However, there is no standard-based protocol defined and implemented to access imaging reports from the EMR applications.
As the countries and jurisdictions move forward with their EMR programs the distribution of hospital reports, including DI reports, is seen as a key benefit of EHR-EMR interoperability to providers. As such, they are looking for architectural guidance and on the use of standards for access to DI reports.
DI reports fall into the wider universe of clinical documents including discharge summaries, care summaries and referral notes, which follow common workflow patterns when viewed from the perspective of a primary care provider.
There is a strong business driver for a common approach to integrating structured documents into the EHR that would simplify integration of consumer systems with the EHR.
Canada, UK and Denmark among others have adopted HL7 CDA as the document content format to standardize DI Reports and have started to document and provide guidance for implementing DI Reports based on CDA. This proposal to IHE Radiology is to ensure international coordination on DI Report Content and to align already existing international efforts with the overall goal to accelerate exchange and access to DI reports from consumer systems used by primary care physicians.
3. Key Use Case
DI reports fall into the wider universe of clinical documents including discharge summaries, care summaries and referral notes, which follow common workflow patterns when viewed from the perspective of a primary care provider. Users, in particular primary care physicians, want access to DI Reports from within their EMRs regardless where the images were acquired and reports created. With the emerging availability of XDS based exchange networks common and standardize access to DI Reports must be provided for. The use case for accessing DI Reports is is similar for accessing any clinical documents and results from tests that the primary care physician has requested for his/her patient. Within XDS the user is using therefor an XDS consumer to access the DI Report that displays the information in a consistent and human readable manner, regardless which application created the report or where the report was created.
4. Standards and Systems
The proposed content profile should be aligned with existing work done in Patient Care Coordination (e.g. MS) and Cardiology (e.g. CIRC)
The proposed content profile provides guidance for distribution and access to DI Reports aligned with XDS/XDR/XDM
The proposed content profile shall be based on HL7 CDA as the document content format
5. Discussion
The proposed content profile leans on effort underway as part of Canada Health Infoway's Standard Collaborative Working Group 10 (Diagnostic Imaging). Aligning this work with other national initiatives in the UK and Denmark, among others, by IHE Radiology saves effort and improves overall coordination and guidance. Ultimately leading to better and consistent exchange and access to DI Reports.
Existing content formats used in Radiology such as DICOM SR fail to satisfy the requirements of access by simple EMRs used by primary care physicians. In addition, adoption and consistent use of DICOM SR by Radiology vendors is lacking providing significant practical implementation challenges. Alternatively PDF could be used but this doesn't leave the opportunity for structured content and future alignment with lexicon, terminology standards and report templates based on the work done by RSNA. For these reasons HL7 CDA has been chosen by Canada, Denmark and UK and is proposed as the document content format for this proposed content profile.
The scope for the coming year might only be on providing the content for the header and body and a template for basic/common DI report, however future work might include alignment with the reporting effort underway by RSNA and provide structured content based on the RSNA Report Templates project. Future effort will also ensure proper specifications of mappings for RadLex codes, although the use of RadLex codes will remain optional.
As content profile this proposal would create a new content creator and content consumer actor.
A lot of effort/work has been done by other domains that should be leveraged.