Displayable Reports Profile (DRPT) Marco Eichelberg OFFIS Technical Manager, IHE Europe Cardiology Slides by Harry Solomon, Co-chair, IHE Cardiology Technical Committee

Participant Workshop2 The Problem Most existing reporting applications operate with paper paradigm –Print –Scribble (signature) –Fax Advanced apps have some electronic capabilities –Storage / database –Electronic signature –Fax from system Increasing demand for electronic report to central repository –Inconsistent requirements for how to do this

Participant Workshop3 Displayable Reports Profile Abstract / Scope Management of Portable Document Format (PDF) formatted clinical reports –PDF retains many desirable features of paper-based reports, e.g., controlled display format, graphics Creation, signature/release, and distribution Report repository/archive –Archive at one level (nominally the department) is required –Additional archive at second level (enterprise) supported Standard format for electronic submission to central enterprise repository/registry –PDF document, or only document reference (URL)

Participant Workshop4 Displayable Reports Profile Value Proposition Many clinical reporting applications use, or can be readily adapted to use, PDF for their display-ready reports PDF supports graphical content (critical to cardiology reports) PDF allows the source system to control the look of the report, which is important for both clinical and business reasons –In certain areas, it may also be a legal requirement for the presentation of a report to be identical in all presentation contexts The Displayable Reports Profile specifies a consistent set of actors and transactions supporting the creation, revision, intra- and inter- department transmission, and reading of reports in PDF format Image Manager/Image Archive may be leveraged as departmental Report Repository Distributed enterprise report storage architecture supported

Participant Workshop5 Example Displayable Reports

Participant Workshop6 Displayable Reports Profile Transaction Diagram Encapsulated Report Storage [CARD-9] Report Repository Report Manager Enterprise Report Repository Encapsulated Report Query [CARD-10] Encapsulated Report Retrieve [CARD-11] Report Reader Report Creator Encapsulated Report Submission [CARD-7] Storage Commitment [RAD-10] Encapsulated Report Submission [CARD-7] Display Retrieve Specific Info for Display [ITI-11] Retrieve Document for Display [ITI-12] Information Source Report Reference Submission [CARD-8] Retrieve Information for Display (RID) Profile

Participant Workshop7 Displayable Reports Profile Actors Report CreatorReport Creator – A system that generates and transmits clinical reports. Report ManagerReport Manager – A system that manages the status of reporting, and distributes reports to report repositories. Report ReaderReport Reader – A system that can query/retrieve and view reports encoded as DICOM objects. Report RepositoryReport Repository – A departmental system that receives reports and stores them for long-term access. Information Source –Must be grouped with Information Source actor - A system that responds to requests for specific information or documents and returns ready-for-presentation information to be displayed by the requesting actor. Enterprise Report RepositoryEnterprise Report Repository – A system that receives reports and/or references (pointers) to reports, and stores them for access throughout the healthcare enterprise.

Participant Workshop8 Displayable Reports Profile Standards Used PDF – report content format HL7 v2 – Encapsulated Report Submission, and Report Reference Submission –ORU DICOM – Encapsulated Report Storage, Query, and Retrieve –Encapsulated PDF Storage –Storage Commitment –Query –Retrieve

Participant Workshop9 DRPT - Standards Used Encapsulated Report Storage [CARD-9] Report Repository Report Manager Enterprise Report Repository Encapsulated Report Query [CARD-10] Encapsulated Report Retrieve [CARD-11] Report Reader Report Creator Encapsulated Report Submission [CARD-7] Storage Commitment [RAD-10] Encapsulated Report Submission [CARD-7] Report Reference Submission [CARD-8] MSH|^~\$|… PID|1| ||R… OBR|1|X ^… OBX|1|ED| ^LN… HL7 MSH|^~\$|… PID|1| ||R… OBR|1|X ^… OBX|1|ED| ^LN… MSH|^~\$|… PID|1| ||R… OBR|1|X ^… OBX|1|ED| ^LN… HL7 MSH|^~\$|… PID|1| ||R… OBR|1|X ^… OBX|1|ED| ^LN… MSH|^~\$|… PID|1| ||R… OBR|1|X ^… OBX|1|RP| ^LN… uestType=DOCUMENT&d ocumentUID=1.2.3&pref erredContentType=applicat ion/pdf HL7 (0008,0005) IR_100 (0008,0012) (0008,0013) 1109 (0008,0016) … DICOM (0008,0005) IR_100 (0008,0012) (0008,0013) 1109 (0008,0016) … DICOM Display Retrieve Specific Info for Display [ITI-11] Retrieve Document for Display [ITI-12] Information Source HTTP But how can a non-DICOM Report Manager play?

Participant Workshop10 Displayable Reports Profile Options and Actor Groupings Report Manager may support DICOM Storage option –For use of Image Manager/Archive as Report Repository, using DICOM Encapsulated PDF If DICOM option not implemented, Report Manager must be grouped with Report Repository –Allowed to implement proprietary internal communication DICOM Encapsulated PDF Query/Retrieve is an option for Report Repository –If not implemented, workstations must use RID to access reports Enterprise Report Repository may receive either encapsulated documents, or document references –Report Manager must support both formats (configurable) –Document reference is RID Retrieve Document for Display URL

Participant Workshop11 DRPT – Grouped Report Manager and Repository Report Repository Report Manager Enterprise Report Repository Encapsulated Report Query [CARD-10] Encapsulated Report Retrieve [CARD-11] Report Reader Report Creator Encapsulated Report Submission [CARD-7] Report Reference Submission [CARD-8] MSH|^~\$|… PID|1| ||R… OBR|1|X ^… OBX|1|ED| ^LN… MSH|^~\$|… PID|1| ||R… OBR|1|X ^… OBX|1|ED| ^LN… HL7 MSH|^~\$|… PID|1| ||R… OBR|1|X ^… OBX|1|ED| ^LN… MSH|^~\$|… PID|1| ||R… OBR|1|X ^… OBX|1|ED| ^LN… HL7 MSH|^~\$|… PID|1| ||R… OBR|1|X ^… OBX|1|ED| ^LN… MSH|^~\$|… PID|1| ||R… OBR|1|X ^… OBX|1|RP| ^LN… uestType=DOCUMENT&d ocumentUID=1.2.3&pref erredContentType=applicat ion/pdf HL7 Display Retrieve Specific Info for Display [ITI-11] Retrieve Document for Display [ITI-12] Information Source HTTP DICOM option not implemented

Participant Workshop12 Summary of Requirements – Report Creator Create PDF report Create HL7 v2 ORU message –Include DICOM Study UID in OBX segment if associated with a DICOM Procedure –Encapsulate PDF in OBX segment –Set status in ORC and OBX segments –Send to Report Manager Does NOT persistently (long-term) store reports –Report Manager is responsible for content of released report, and any local storage on Report Creator may become inconsistent with official report (e.g., on Patient Update)

Participant Workshop13 Summary of Requirements – Report Manager Receive PDF encapsulated in HL7 v2 ORU message Manage release of report –May release preliminary, or only final (per product feature or configured rules) –Optionally manage electronic signatures –Add cover page in PDF with correct demographics and signature/status Store report –Via DICOM Encapsulated PDF to ungrouped Report Repository –Via unspecified means to grouped Report Repository Forward report to Enterprise Report Repository –Via encapsulated PDF and/or via RID URL, as configured

Participant Workshop14 Report Manager Issues Must support external Report Creators, even if product groups a Report Creator with Report Manager Report Manager may not restrict types of reports (report titles) it supports –Unlike a DICOM Image Manager, which may restrict the types of images it supports –All Displayable Reports are fundamentally the same – an encapsulated PDF, which is not semantically processed Report Manager actor also appears in Patient Information Reconciliation Profile –For Patient Update and Procedure Update transactions Report Manager may be an enterprise-level actor

Participant Workshop15 Summary of Requirements – Report Repository (ungrouped) Receive PDF encapsulated in DICOM message Serve report via RID Information Source using HTTP Get –Summary List of Reports –Bare PDF report document Serve report via DICOM –DICOM Query/Retrieve of Encapsulated PDF Reasonable functionality to add to Image Manager / Image Archive (PACS)

Participant Workshop16 Summary of Requirements – Report Reader Query/Retrieve DICOM Encapsulated PDF –Allows access to report in context of study images and evidence – retrieve of complete DICOM study will also retrieve report Render PDF content Reasonable functionality to add to Image Display (workstation)

Participant Workshop17 Summary of Requirements – Enterprise Report Repository Receive PDF encapsulated in HL7 v2 ORU message or Receive PDF reference in HL7 v2 ORU message Serve report to enterprise via unspecified mechanism –Additional to RID service from Report Repository actor –Enterprise Report Repository may implement references only (fully distributed architecture)

Participant Workshop18 DRPT and XDS Displayable Reports Profile specifies production of reports within an organization Cross-enterprise Document Sharing (XDS) Profile specifies distribution of reports outside the organization Typically, only a subset of internally generated reports will be shared outside Externally shared reports must be identified with Patient ID used in the XDS Affinity Domain XDS Document export is a reasonable function to group with the Enterprise Report Repository

Participant Workshop19 More information…. IHE Web sites: Technical Frameworks, Supplements Cardiology Technical Framework IT Infrastructure Technical Framework Displayable Reports Supplement Non-Technical Brochures : Calls for Participation IHE Fact Sheet and FAQ IHE Integration Profiles: Guidelines for Buyers IHE Connect-a-thon Results Vendor Products Integration Statements

Participant Workshop20 W W W. I H E. N E T Providers and Vendors Working Together to Deliver Interoperable Health Information Systems In the Enterprise and Across Care Settings