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

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

• Proposal Editor: Teri Sippel Schmidt/Karos Health, David Clunie/CoreLab Partners
• Editor: Teri + David
• Contributors: Teri Sippel Schmidt/Karos Health, David Clunie/CoreLab Partners, 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

Overview: This is a white paper proposal, not a profile proposal. The intent is to align two RSNA initiatives more closely and increase adoption of both by making the subject less overwhelming/giving IHE developers a better and more unified starting point. Because the RadLex committee co-chair is participating as an author/editor of this whitepaper to ensure the RadLex committee is in direct agreement with the white paper.

Existing problem: There is currently no documentation to assist or define how to use properly use the different RadLex code sets in the Radiology Workflow profile. DICOM and IHE do not define which code sets to use for scheduled procedure steps, etc.,(and should not), but to provide better consistency and to make adoption of RadLex easier for developers, a discussion leading in the correct direction would be appropriate.

Key Integration Feature/Problem Solved: The IHE Radiology Scheduled Workflow Profile has an appendix has done a significant amount of work to define data mappings between SPS, MPPS, objects, etc. This intent of this white paper would be to illustrate which RadLex codes would be used in these various elements, especially beginning with the SPS.

Market Interest: The RSNA has significant investments in both the IHE and the RadLex development and it only makes sense to bring the two efforts together to promote cross-awareness and cross-adoption.

Venue: The only two real venues for this white paper are IHE and the RadLex commitee. The intent is that this documentation effort will follow the IHE publication process because it is very rigorous, but would be published in both venues.

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 which is sent to the DSS/OF (RIS). A tech refines the order to a specific procedure. This procedure code should be 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).

Which parts of RadLex tree lexicon get mapped and where? There is an appendix (App A of Vol 2) to the IHE Rad Scheduled Workflow Profile which goes into excrutiating detail regarding data element mappings, but this white paper would be more specific to which branches of the RadLex lexicon get mapped into which elements in the various steps, beginning with the SPS, but following through the entire profile.

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

5. Technical Approach

This is a white paper, not a new/extended profile.

The intent would be to demonstrate where and how to map which parts of the RadLex tree (see RadLex Tree Browser at www.radlex.org for clarification) to:

• 1.) possibly: The OBR segment in Transaction 3: Filler Order Management
• 2.) more directly: Transaction 4: Procedure Scheduled; especially focusing on Table 4.4-6: DSS mappings of the OBR Segment
• 3.) Then to verify that the different use cases in the mapping tables in Appendix A of Volume 2 entitled "APPENDIX A: ATTRIBUTE CONSISTENCY BETWEEN MODALITY WORKLIST, COMPOSITE IODS, EVIDENCE DOCUMENTS, KIN AND MODALITY PERFORMED PROCEDURE STEP" do not need additional discussion.

Obviously, the intent of this white paper is remain consistent with the data model defined in the IHE profile.

Existing actors

Primarily, the DSS/OF, Modality, and Image Manager would need to be capable of using the RadLex Code sets. However, today, for the large majority of these real-world devices, the code sets are configurable already.

New actors

No new actors.

Existing transactions

Please see the list above in Section 5.

New transactions (standards used)

No new transactions.

Impact on existing integration profiles

No impact on existing profiles, except possibly a reference to the white paper on the wiki somehow associated with the IHE Radiology Scheduled Workflow Profile.

New integration profiles needed

No new profiles.

Breakdown of tasks that need to be accomplished

The primary task of both the IHE Radiology Technical Committee and the RadLex committees will be to review the White Paper to verify that the intended mapping are correct. It is expected that the white paper will be 3 to 5 pages in length, hopefully closer to the former.

6. Support & Resources

The RadLex Committee has agreed to participate in the White Paper review and Daniel Rubin, MD, co-chair RSNA RadLex Committee has agreed to be a co-editor.

7. Risks

This is seen as a low technical risk proposal.

8. Open Issues

There are relatively few open issues, just need to write it up. Please note that this was trialed (successfully) at the RSNA 2011 Image Sharing Demonstration, including mapping the SPS procedure code to a modality protocol.

It may be helpful to get the procedure codes used in the Connectathon testing to change to using RadLex codes.

The question of the use of SNOMED, especially in Canada, possibly for procedure codes and in light of the post-coordination of laterality in SNOMED procedure codes, could be addressed, but since RadLex-LOINC harmonization has not yet been extended to SNOMED, may be impractical, as well as require expertise that is not available.

9. Tech Cmte Evaluation

Effort Evaluation (as a % of Tech Cmte Bandwidth):

• 20%

Responses to Issues:

• Harmonization with SNOMED procedure codes is out of scope

Candidate Editor:

Teri + David