Working in an Integrated Digital Healthcare Enterprise 2004
Introduction and Update to HL7 and DICOM
Herman Oosterwijk, Adjunct faculty, University of North Texas President OTech Inc.
[email protected] www.otechimg.com
DICOM/HL7 slide 1
Working in an Integrated Digital Healthcare Enterprise 2004
Agenda:
! What is HL7 ! What’s new in HL7 ! What is DICOM ! What’s new in DICOM ! Conclusion, Q and A
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DICOM/HL7 what’s new? Herman Oosterwijk www.otechimg.com page 1 Working in an Integrated Digital Healthcare Enterprise 2004
What is HL7:
! A pragmatic, simple protocol to exchange information dealing with, for example: ! Patient registration ! Orders (clinical, radiology, laboratory, etc.) ! results and observations ! queries, e.g. for patient demographics ! finance for billing purposes ! master files and indexes ! document control, such as approval status ! scheduling and logistics
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Working in an Integrated Digital Healthcare Enterprise 2004
Information Workflow example: Broker System Ordering, Scheduling
Modality Worklist Mgt
HL7
Storage Archive
Storage Cmt Reporting
Retrieve
Performed Procedure Viewing Step
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DICOM/HL7 what’s new? Herman Oosterwijk www.otechimg.com page 2 Working in an Integrated Digital Healthcare Enterprise 2004
DICOM vs HL7 ! Scope is Imaging ! Scope beyond Imaging ! Protocol is mainly ! Protocol is Event driven, Client/Server i.e. unsolicited Events ! Based on Object ! Object Oriented in v 3.0 Oriented principles ! Attributes encoded ! Attributes: text strings
! Conformance ! Conformance varies, site specified in dependent, requires on- Conformance site modifications and statements validation (I/F engine)
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Working in an Integrated Digital Healthcare Enterprise 2004 DICOM vs HL7 ! Not Web Friendly ! 3.0 based on XML; (MIME and WADO) CCOW part of spec ! Encoding uses tags, ! No tags, defined variable length fields sequence delimiters ! Each field has ! Length specifications for maximum length multiple fields ! Implementations ! Implementation follows follow new additions new standard 5-10 years in 1-3 years ! “standard” ! “guideline”
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DICOM/HL7 what’s new? Herman Oosterwijk www.otechimg.com page 3 Working in an Integrated Digital Healthcare Enterprise 2004 HL 7 messaging: ! Message contains group of segments in a defined sequence. ! The “event” segment identifies the event type (“trigger event”) ! e.g. EVN|A01|2000…… ! A01 ADT - Admit/visit notification ! A02 ADT - Transfer a patient ! A03 ADT - Discharge/end visit ! A04 ADT - Register patient ! A05 ADT - Pre-admit patient
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Working in an Integrated Digital Healthcare Enterprise 2004
HL 7 example message:
ORM General Order MessageChapter MSH Message Header 2 PID Patient Identification 3 PV1 Patient Visit 3 { ORC Common Order 4 OBR } Order Detail 4
! Information about the message: MSH ! Information about the patient: PID, PV1 ! Information about the Order (ORC, OBR)
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DICOM/HL7 what’s new? Herman Oosterwijk www.otechimg.com page 4 Working in an Integrated Digital Healthcare Enterprise 2004 HL 7 example message:
MSH|^~\&|RadNet Interface Engine|INPHNA|||19991222122639||ORM^O01|1999 1222122639|P|2.3|||AL|NE|||
PID|||CHSICL153312||JONES^JAMES L||19440127000000|M|||329 OLD KINSER RD^^CLEVELAND^TN^37323|||||||3083672||||||||||||
ORC|NW|A.1|CHSICL990000421||||||1999122212263 9|||^ADDIS^HUNTER|ER^^^CHSICL||19991222121 800|^TEST THREE|||
OBR||A.1|CHSICL990000421|71010^CHEST 1 VIEW^L||19991222121800||||||||||^ADDIS^HUNTER|| 1|RG|||||||||||||||||19991222121800|||||||
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Working in an Integrated Digital Healthcare Enterprise 2004
HL 7 CCOW:
! Clinical Context Object Workgroup: ! single user workstation ! multiple disparate applications ! easy access of consistent data through common context: ! patient link, user link ! IHE tech infrastructure is using it
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DICOM/HL7 what’s new? Herman Oosterwijk www.otechimg.com page 5 Working in an Integrated Digital Healthcare Enterprise 2004
HL 7 CCOW:
! Architecture:
Application 2
Application 1 Context Mgr. Application 3
Optional Patient Mapping agent
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Working in an Integrated Digital Healthcare Enterprise 2004
HL 7 CDA:
! Clinical Document Architecture: ! A container for “consistent objects”, in other words, the starting of an electronic patient record (can exist “outside” message) ! Mapping of DICOM objects (SR!) to CDA being defined ! Driven by German HL7 organization
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DICOM/HL7 what’s new? Herman Oosterwijk www.otechimg.com page 6 Working in an Integrated Digital Healthcare Enterprise 2004
HL 7 CDA (cont):
! A “gradual” transition to 3.0: encapsulated as MIME packages (payload) in HL7 messages (2.x or 3.0) ! Level 1,2,3 specified with increasing constraints ! Documents derive meaning from 3.0 RIM and use 3.0 data types ! Basically a hierarchical set of document specifications
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Working in an Integrated Digital Healthcare Enterprise 2004
HL 7 EHR:
! Electronic Health record initiative ! Largest ballot response ever in HL7 history ! First draft to be rewritten; febr 2004 ! Major impact on implementations expected through CMS push ! Functional specification is key; will be a “Draft Standard for Trial Use”
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DICOM/HL7 what’s new? Herman Oosterwijk www.otechimg.com page 7 Working in an Integrated Digital Healthcare Enterprise 2004
HL 7 EHR (cont)
! Three components: ! Direct care ! Supportive functions (ADT, etc) ! Information Infrastructure ! Care setting will be country specific ! Features categorized: ! Essential, Immediate, Essential future, Optional, N/A
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Working in an Integrated Digital Healthcare Enterprise 2004
EHR, the ultimate integration example:
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DICOM/HL7 what’s new? Herman Oosterwijk www.otechimg.com page 8 Working in an Integrated Digital Healthcare Enterprise 2004 HL 7 3.0:
! Reduces optionality: more specific messaging ! Specifies behavior of receiver: specifies Classes similar as DICOM ! Built around a common model (RIM) ! Harmonization of extensions through reference model only ! Can be mapped into HL7 2.x, NOT backwards compatible ! Facilitates conformance claims
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Working in an Integrated Digital Healthcare Enterprise 2004 HL 7 3.0 (cont):
! Several counties are spear-heading; Britain (NHS) initiative will be very influential ! Early experiences are very promising with regard to integration effort ! Facilitates object oriented technologies ! First version will include XML as communication layer I/F; ! Can use off the shelf tools ! Web “ready”
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DICOM/HL7 what’s new? Herman Oosterwijk www.otechimg.com page 9 Working in an Integrated Digital Healthcare Enterprise 2004
What is DICOM:
! An exchange protocol dealing with: ! Image, and related information exchange: ! Measurements ! Annotations, presentation ! Image quality ! Worklists ! Printing of images ! Image and Information Management ! DICOM Object retrieval ! Output of image related data: CAD, Logs…
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Working in an Integrated Digital Healthcare Enterprise 2004
Information Workflow example: Broker System Ordering, Scheduling
Modality Worklist Mgt
HL7
Storage Archive
Storage Cmt Reporting
Retrieve
Performed Procedure Viewing Step
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DICOM/HL7 what’s new? Herman Oosterwijk www.otechimg.com page 10 Working in an Integrated Digital Healthcare Enterprise 2004 DICOM messaging:
! Message contains command (Store, Find, Get, Set, Action…) and object (image, list….) ! Commands for persistent objects (e.g. Images) as well as normalized objects (e.g. print queue): ! C: Store, Find, Get, Move, Echo ! N: Set, Get, Action, Event-Report, Create, Delete ! Connections are always negotiated (What/How)
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Working in an Integrated Digital Healthcare Enterprise 2004 DICOM example message Tag-Length-Value: 0008,0005-10-ISO_IR 100 (char set) 0008,0008-22-ORIGINAL\PRIMARY\AXIAL (image Type) 0008,0016-26-1.2.840.10008.5.1.4.1.1.2 (SOP Class) 0008,0018-46-1.2.840.1936523.4.5.1.198745.. (SOP Instance) 0008,0020-8-19990702 (study date) 0008,0030-6-113004(study time) 0008,0050-10-046-73-303 (accession #) 0008,0060-2-CT (modality) 0008,0070-8-otechinc (manufacturer) ……. 7FE0,0010-64000-82368390288994988.. (pixel data) DICOM/HL7 slide 22
DICOM/HL7 what’s new? Herman Oosterwijk www.otechimg.com page 11 Working in an Integrated Digital Healthcare Enterprise 2004
What’s new in DICOM:
! New Modalities ! MR and CT (spectroscopy, multiframe) ! CAD output definitions (mammo, lung nodules) ! Structured reports for measurements (US, Cath, QCA/QVA) ! Configuration management (AE title’s, DHCP, NTP) ! Security (CMS, encryption)
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Working in an Integrated Digital Healthcare Enterprise 2004
What’s new in DICOM (cont):
! Web enabling (MIME, WADO) ! Clinical trial information ! Conformance statements ! DICOM standard definition in XML ! USB and flash media ! Enhanced XA and RF ! N-D imaging ! Registration ! MPEG ! Image presentation (Color, Hanging protocols) DICOM/HL7 slide 24
DICOM/HL7 what’s new? Herman Oosterwijk www.otechimg.com page 12 Working in an Integrated Digital Healthcare Enterprise 2004 IHE Profiles: Scheduled Workflow Patient Information Post- Processing Charge Posting Reconciliation Workflow Admit, order, schedule, acquire Schedule, perform, & Collection of billable images, notify of completed steps Unknown patients and notify image processing procedure details unscheduled orders & CAD steps
Consistent Presentation Key Image Simple Image and of Images Notes Numeric Reports Simple reports with image Hardcopy and softcopy Flag significant links and, optionally, grayscale presentation state images measurements
Presentation of Grouped Procedures Subset a single acquisition
Access to Radiology Information Consistent access to images and reports
Basic Security Audit Trail Consolidation & Node Authentication
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Working in an Integrated Digital Healthcare Enterprise 2004 Conclusion:
! HL7 and DICOM are converging, especially when HL7 3.0 becomes available ! They both have their own, distinct domain ! Both standards are continuously changing and new versions are being balloted to facilitate new modalities, increasing integration and new technologies ! IHE facilitates profiles, defining “options” and mapping interface ! Learning about these standards is not hard, books, courses are available (even on-line)
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DICOM/HL7 what’s new? Herman Oosterwijk www.otechimg.com page 13 Working in an Integrated Digital Healthcare Enterprise 2004
Resources/Questions/Remarks:
! Remarks/Questions: [email protected] ! IHE specifications available at www.rsna.org/IHE ! DICOM standard and proposals available at http://medical.nema.org ! Books, e-learning, classes on DICOM and HL7: www.otechimg.com
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DICOM/HL7 what’s new? Herman Oosterwijk www.otechimg.com page 14