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Intro to HL7 and DICOM

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Intro to HL7 and DICOM 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 DICOM/HL7 slide 2 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 DICOM/HL7 slide 3 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 DICOM/HL7 slide 4 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) DICOM/HL7 slide 5 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” DICOM/HL7 slide 6 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 DICOM/HL7 slide 7 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) DICOM/HL7 slide 8 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||||||| DICOM/HL7 slide 9 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 DICOM/HL7 slide 10 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 DICOM/HL7 slide 11 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 DICOM/HL7 slide 12 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 DICOM/HL7 slide 13 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” DICOM/HL7 slide 14 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 DICOM/HL7 slide 15 Working in an Integrated Digital Healthcare Enterprise 2004 EHR, the ultimate integration example: DICOM/HL7 slide 16 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 DICOM/HL7 slide 17 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” DICOM/HL7 slide 18 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… DICOM/HL7 slide 19 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 DICOM/HL7 slide 20 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) DICOM/HL7 slide 21 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) DICOM/HL7 slide 23 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
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