White Paper - Mapping RadLex Codes into the IHE Radiology Scheduled Workflow Data Model - Detailed Proposal - 2012-2013

1. Proposed Workitem: Detailed Proposal: White Paper- Mapping RadLex Codes into the IHE Radiology Scheduled Workflow Data Model

• Proposal Editor: Teri Sippel Schmidt/Karos Health, David Clunie
• Editor: Teri Sippel Schmidt/Karos Health, David Clunie, Daniel Rubin/Stanford (RadLex chair), more pending their formal agreement
• Date: N/A (Wiki keeps history)
• Version: N/A (Wiki keeps history)
• Domain: Radiology

Summary

<Summarize in a few lines the existing problem . E.g. "It is difficult to monitor radiation dose for individual patients and almost impossible to assemble and compare such statistics for a site or a population.">

<Demonstrate in a line or two that the key integration features are available in existing standards. E.g. "DICOM has an SR format for radiation dose events and a protocol for exchanging them.">

<Summarize in a few lines how the problem could be solved. E.g. "A Radiation Dose profile could require compliant radiating devices to produce such reports and could define transactions to actors that collect, analyze and present such information.">

<Summarize in a line or two market interest & available resources. E.g. "Euratom and ACR have published guidelines requiring/encouraging dose tracking. Individuals from SFR are willing to participate in Profile development.">

<Summarize in a line or two why IHE would be a good venue to solve the problem. E.g. "The main challenges are dealing with the chicken-and-egg problem and avoiding inconsistent implementations.">

2. The Problem

Integration Problem:

• RSNA members have spent several years creating a comprehensive radiology coding scheme called RadLex (www.radlex.org and playbook.radlex.org ) which includes both a radiology lexicon as well as a procedure playbook (procedure codes). Currently, RadLex is a standalone list of values, codes and definitions, albeit a comprehensive list.
• At the RSNA 2012 Image Sharing demonstration, a significant effort was undertaken to use only RadLex codes throughout the entire demonstration including all of Scheduled Workflow, RSNA Report Templates, XDS/XDS-I, REM and TCE. There is little to no documented guidance on how and where to use the various RadLex codes in the IHE world. A concerted effort was made to get these mappings working for the trade show, and, for the most part, it seemed to work (well). In retrospect, however, several of the mappings were probably not quite correct.

Value Statement: We would like to take what we learned at the trade show, refine it, document and publish it for two reasons: (1) the next group(s) of vendors or clinicians trying to implement RadLex codes would have a better basis to start from and (2) to cross-promote the adoption of RadLex in the vendor and clinical communities.

3. Key Use Case

A referring physician creates a fairly generic radiology order. A tech refines the order to a specific procedure. This procedure code should get mapped into the IHE data model properly so that it can be transmitted directly to the modality via DMWL and perhaps the modality can even directly convert it to a protocol (as was done in the demo). But, wait, the tech at the modality modifies the procedure (PPS). And so it continues down the line.

Which types of RadLex codes get used and where? There is an appendix to Scheduled Workflow that goes into excrutiating detail regarding data element mappings, but this would be more specific to RadLex.

4. Standards and Systems

Systems:

• Maybe the Order Placer, but doubtful
• Department System Scheduler/Order Filler (DSS/OF)
• Modality Performed Procedure Step Manager (MPPS Mgr)
• PACS
• Reporting system
• Modality

Standards:

• RadLex
• IHE Radiology Scheduled Workflow
• reporting - not exactly sure which profile yet
• tangentially XDS/XDS-I

<DELETE THIS SEC 5> ==5. Discussion==

This is a white paper proposal, not a profile proposal. The intent is to align two RSNA initiatives more closely and increase adoption by making the subject less overwhelming/giving IHE developers a better and more unified starting point. It is our intent to keep the RadLex committee members closely involved so that they are in agreement with the direction of the white paper.

5. Technical Approach

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Existing actors

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New actors

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Existing transactions

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New transactions (standards used)

<Describe possible new transactions (indicating what standards would likely be used for each. Transaction diagrams are very helpful here. Feel free to go into as much detail as seems useful.>

Impact on existing integration profiles

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New integration profiles needed

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Breakdown of tasks that need to be accomplished

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6. Support & Resources

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7. Risks

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8. Open Issues

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9. Tech Cmte Evaluation

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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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