IHE Eye Care “Evidence Documents” IHE Workshop 2006 - Changing the Way Healthcare Connects Donald Van Syckle DVS Consulting, Inc. Jim Riggi, CTO Medflow, Inc. Co-Chair IHE Eye Care Technical Committee

Evidence Documents An extension of the Eye Care SWF profile (i.e. actors must support SWF before supporting Eye Care ED) Measurements, observations and coded data created using DICOM objects Typically created by either an Acquisition Modality or Evidence Creator (i.e. eye care instruments, standalone workstations, EMRs, etc.) June, 2006

Evidence Documents Produced during acquisition or post-processing workflows May be Interpreted along with images or stand alone Either DICOM Structured Reports (SR) or DICOM Encapsulated PDF June, 2006

Eye Care Evidence Documents Examples Glaucoma progression analysis performed on visual field analyzers RNFL analysis performed on an OCT device Measurements on fundus images Measurements on anteriour chamber OCT images for phakis IOL implantation planning Corneal ablation planning based on corneal topography maps Others…. June, 2006

DICOM Structured Report (SR) The DICOM object used by IHE for reporting Reports that include actual measurement values, observations and/or coded data to describe eye care evidence Eye Care specific DICOM SRs being defined by WG9 – IHE will adopt upon completion Keratometer, Autorefractor, Lensometer, biometry, visual fields Note: Fundus measurements may be possible using Simple Image and Numeric DICOM SR, but has yet to be reviewed by WG9 June, 2006

Eye Care Extension DICOM Encapsulated PDF Also includes measurement values, observations and/or coded data to describe eye care evidence However, DICOM Encapsulated PDF is a “display only” solution Is used when no specific DICOM SR solution is defined Note - since there are no current DICOM SRs defined for Eye Care, it is expected that only DICOM Encapsulated PDF will be used in the AAO showcase June, 2006

Evidence Document Stored Query / Retrieve Storage Commitment Evidence Document Stored June, 2006

Evidence Documents Professional Report Images Interpretation Header: ….. Findings: Image Refs.: Header: Report Type: …… Retinal.. ... Eye Care Impressions: ……. … Interpretation Images June, 2006

Managed Like Images Evidence Documents can be transferred, stored, and query/retrieve just like images Exists in the same study as images Patient Information Patient ID Study Information Study Inst. UID Series Information Series Information Series Information Series Information Series Inst. UID Image DICOM Encp. PDF SR Evidence Document Other Composite IODs SOP Inst. UID June, 2006

ED a Part of Performed Procedure Step` Image Patient Imaging Serv. Req. (Order) Requested Procedure Scheduled Procedure Step Study Mgt Performed Procedure Step Study Series ED A PPS is an “Atomic Imaging/Measurements Exam” A PPS Starts and Ends. It is never resumed ! A PPS produces one or more series of images/evidence documents Once a PPS is completed, images/evidence documents cannot be added to a series Additional PPS can always be performed A Study usually holds the work product for a Requested Procedure A Study may be multi-modality (I.e. multiple instruments) June, 2006

Workflow June, 2006

Example – Acquisition Modality Images have been taken at an Acquisition Modality After image acquisition, the Acquisition Modality performs post processing such as: a glaucoma progression analysis RNFL analysis performed on an OCT device Others….. Evidence Documents are created using DICOM SR or DICOM Encapsulated PDF Evidence Documents are: stored in the same Study as the images (in a separate series) tracked using DICOM MPPS sent to the storage server securely stored using Storage Commitment June, 2006

Example – Workstation, EMR Unscheduled post-processing done after the acquisition, products support both the Image Display Actor and Evidence Creator Actor Use DICOM query/retrieve to acquire previous images and/or measurements then perform post-processing measurements on fundus images corneal ablation planning based on corneal topography maps measurements on anterior chamber OCT images for phakic IOL implantation planning Others… Evidence documents are: either DICOM SR or DICOM Encapsulated PDF stored in the same study as created by the Acquisition Modality sent to the storage server securely stored using Storage Commitment June, 2006

IHE Generic Keys for Query Retrieve of: - Images - Evid. Doc. - SR R = Required and the SCU shall be able to display R+ = IHE Requirement on top of DICOM June, 2006

Extension for PDF Query How to store, query, retrieve for Evidence Documents is defined by SWF DICOM SR queries for Evidence Documents have been defined by radiology Eye Care added the storage and query for DICOM Encapsulated PDF Added a new display field for the Image Display actors from query, the PDF “Document Title” June, 2006

More information…. IHE Web site: www.ihe.net Technical Frameworks ihe_eyecare_tf_TI_vol1_2006_06_01 (Trial Implementation version) ihe_eyecare_tf_TI_vol2_2006_06_01 (Trial Implementation version) ihe_tf_rev6.0ft_vol1_2005-05-18-FINAL (Radiology) ihe_tf_rev6.0ft_vol2_2005-05-18-FINAL (Radiology) ihe_CARD_tf_vol2_2.1_FT (Cardiology) Standards used by IHE Eye Care DICOM Standard www.nema.medical.org HL7 Standard www.hl7.org IHE Connectathon Oct. 2006 at RSNA HQ IHE Showcase at Nov. 2006 AAO Conference Vendor Products Integration Statements June, 2006

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