Slide 1 Sharing Images without CDs, The Next Imaging Sea Change GE Healthcare Chris Lindop GE Healthcare Interoperability & Standards

In the Beginning: Film

Film – the First Standard for Image Exchange In the beginning…. open image exchange started with one reliable method: FILM Advantage: Everyone can view the Film Issue: to be solved: Inconsistent visual quality Annotations, notes, etc. were attached “stuck-on” IHE Solution: Consistent Presentation of Images (CPI) Integration Profile –Grayscale Standard Display Function (consistent images) –Grayscale Softcopy Presentation State (Annotations)

Radiology Enters the Digital Image Exchange: Portable Media: CDs

Portable Media– the next interop challenge CDs or coasters? Then came the introduction of CDs and other portable media, but for most, was simply coasters for your morning coffee. Issues to be solve: Media in-compatibility Inconsistent viewer capabilities No import method to reviewer’s view station IHE Solution: Portable Data for Imaging (PDI) – Standard media format Basic Image Review (BIR) – Basic Viewer capability requirements Import Reconciliation Workflow (IRWF) – Standard import method

Electronic Images Sharing beyond your Institution The Image Exchange

Slide 7 7 Use of a shared XDS Community-based infrastructure to access Radiology Reports and Images (XDS-I) Hospital Imaging Center Physician Practice Between Radiology and : Imaging specialists Non-imaging clinicians Patients PACS Y PACS Z Radiology -to- Radiology Radiology –to – Physicians Specifies how Radiology Information Objects, Both DICOM Instances and non-DICOM Reports are distributed in an eHealth Community 7

XDS Affinity Domain Considerations Set of organizations/systems organized around a single Registry Common set of Codes Single Patient ID Domain Involves business and legal agreements Security model/agreements

IHE Integration Profiles for Health Info Nets What is available and in trial implementation Emergency Referrals Format of the Document Content and associated coded vocabulary PHR Extracts/Updates Format of the Document Content and associated coded vocabulary ObGyn Documents Format of the Document Content and associated coded vocabulary Lab Results Document Content Format of the Document Content and associated coded vocabulary Scanned Documents Format of the Document Content Imaging Information Format of the Document Content and associated coded vocabulary Medical Summary ( Meds, Allergies, Pbs) Format of the Document Content and associated coded vocabulary Clinical and PHR Content Health Data Exchange Patient Demographics Query Patient Identifier Cross-referencing Map patient identifiers across independent identification domains Document Subscription and Notification Request Form for Data Capture External form with custom import/export scripting Patient ID Mgmt Other Final Text Approved Trial Implementation Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a longitudinal record Cross-Enterprise Document Pt-Pt Reliable Interchange Cross-Enterprise Document Media Interchange Cross-Community Access Security & Privacy Consistent Time Coordinate time across networked systems Audit Trail & Node Authentication Centralized privacy audit trail and node to node authentication to create a secured domain. Basic Patients Privacy Consents Establish Consents & Enable Access Control Document Digital Signature Attesting “true-copy and origin Cross-Enterprise User Assertion Provides Trusted Identity

10 Cross-Enterprise Document Sharing (XDS.b) Actor/Transaction Diagram

Slide 11 XDS-I.b Actors and Transactions Same XDS Infrastructure (Registry and Repositories) for medical summaries and imaging information !

Linking Report to Prior Images and Prior Report Document Repository Document Registry Document Entry Submission Set 3 Prior Study Manifest Document Entry Submission Set 1 Prior Report Document Entry Submission Set 2 Report Document Entry Submission Set 4 Study Manifest

13 Shared Storage Services Enterprise Imaging Center Hospital B Hospital A Emergency Room GP 1 Patient Admin Repository Cross- Enterprise Document Registry (XDS) Cross- Enterprise Document Registry (XDS) Cross-Enterprise Document Sharing Practice Data Centre GP 2 Practice

Electronic Images Sharing beyond ….. Cross-Community Image Exchange

Cross-Community Access of Images (XCA-I) the next Sea change Foundational with Standards incl. DICOM Web services –DICOM WADO-WS supp-148) Interoperable with clinical portals –Compatible with IHE Web services profiles, including Security and privacy Interoperable with PACs and vendor neutral archives –Ready for cloud hosted apps

16 Why extend XDS? XDS only addresses document sharing within an XDS Affinity Domain Cross-Community addresses the questions:  How to share documents between XDS Affinity Domains?  How to share documents with non-XDS Affinity Domains?

17 XCA Transaction Diagram minimum required

18 XCA Transaction Diagram

XCA-I Transaction Diagram

XCA-I Foundational with Standards incl. DICOM Webservices –DICOM WADO-WS supp-148) Interoperable with clinical portals –Compatible with XDS.b, XUA, ATNA Interoperable with PACs and vendor neutral archives –Compatible with XDS-I.b, DICOM-WS –Ready for cloud hosted apps

Imaging Object Change Management (IOCM) IOCM specifies how to communicate changes applied on existing imaging objects to other systems. Changes include (1)rejection due to quality or patient safety reasons, (2)correction of incorrect modality worklist entry selection, (3)expiration due to data retention requirements. IOCM is fully compatible with existing profiles!

22 Providers and Vendors Working Together to Deliver Interoperable Health Information Systems in the Enterprise and Across Care Settings