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