Radiology Imaging Report Content Profile - Detailed Proposal - 2012-2013
1. Proposed Workitem: Radiology Imaging Report Content Profile
- Proposal Editor: Michel Pawlicz/Karos Health, Teri Sippel Schmidt/Karos Health
- Editor:
- Contributors: Teri Sippel Schmidt/Karos Health, Michel Pawlicz/Karos Health, Kinson Ho/Agfa Healthcare
- Date: N/A (Wiki keeps history)
- Version: N/A (Wiki keeps history)
- Domain: Radiology
Summary
Overview: Healthcare professionals using simple information systems to access health records want access to diagnostic imaging reports.
Existing Problem: Currently there is no unified standard-based format defined and implemented to access imaging reports from simple EMR applications.
Key Integration Feature/Problem Solved: We propose to create a content profile to define the diagnostic imaging report based on HL7 CDA, leveraging the work done in other domains (IHE PCC), SDOs (DICOM WG 8) and collaborative working groups (HL7 IG CDA-DIR).
Market Interest 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.
Key Benefits 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.
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. 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.
A lot of effort/work has been done by other domains that should be leveraged. Additionally, because over 35 CDA-based content modules have already been tested at the Connectathons, it is hoped that the adoption rate for this profile at the North American Connectathon in January of 2014 will be very high.
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.
Use Case 1: Primary Care Physician want access to DI Report from within their EMR, regardless of where report was created and images where acquired and read.
Use Case 2: Radiologist wants access to prior DI Reports from within the solution she/he is using to diagnose images. DI Report may contain links to (key) images.
Use Case 3: Clinicians, health care professionals in general want access to medical history from within the EHR/EMR including the DI reports for the patients they are providing care to.
Use Case 4: For reporting to national registries the DI report might need to include essential reporting information.
4. Standards and Systems
Systems:
- Department System Scheduler/Order Filler (DSS/OF)
- PACS
- Reporting system
Standards:
- RadLex
- SNOMED CT
- IHE Radiology Scheduled Workflow
- tangentially XDS/XDS-I
- Other IHE content profiles (PCC XDS-MS, CAR CIRC)
- HL7 CDA R2
- HL7 Implementation Guide (IG) for Diagnostic Imaging Reports (DIR)
- DICOM SR (DICOM Supplement 155)
5. Technical Approach
Existing actors
As this is planned to be a content profile we use Content Creator and Content Consumer actors in this context; rather, a new "Radiology Report" content module will be created.
New actors
No new actors are required.
Existing transactions
Existing transactions as defined by XDS, XDS-I, XDR, XDR-I, XDM
New transactions (standards used)
No new transactions are required.
Impact on existing integration profiles
No impact on existing integration profiles is expected.
New integration profiles needed
No new profiles are needed.
Breakdown of tasks that need to be accomplished
<A list of tasks would be helpful for the technical committee who will have to estimate the effort required to design, review and implement the profile.>
6. Support & Resources
<List groups that have expressed support for the proposal and resources that would be available to accomplish the tasks listed above.>
7. Risks
This is seen as a low technical risk proposal.
8. Open Issues
<Point out any key issues or design problems. This will be helpful for estimating the amount of work and demonstrates thought has already gone into the candidate profile.>
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