June 28-29, 2005IHE Interoperability Workshop 1 Integrating the Healthcare Enterprise Cross-enterprise Document Sharing for Imaging (XDS-I) Rita Noumeir Ph.D. University of Quebec IHE Technical and Planning Committees

June 28-29, 2005IHE Interoperability Workshop 2 Abstract / Scope Sharing of Imaging Information across health enterprises Imaging Information includes extensive sets of DICOM instances including images, evidence documents and presentation states diagnostic reports provided in a "for display" form selection of diagnostically significant images associated with the report content

June 28-29, 2005IHE Interoperability Workshop 3 Value Proposition Imaging component of the Electronic Health Record: Shared imaging Record, in a community, region, etc. Effective means to contribute and access imaging documents across health enterprises. Scalable sharing of imaging documents between radiology departments, private physicians, clinics, long term care, acute care with different clinical IT systems. Easy access: Care providers are offered means to query and retrieve imaging documents (images and reports) of interest.

June 28-29, 2005IHE Interoperability Workshop 4 Value Proposition Distributed: Each Care delivery organization publishes imaging information for others. Actual images remain in the source/Image Manager. Cross-Enterprise: A Registry provides an index for published information to authorized care delivery organizations belonging to the same clinical affinity domain. Document Centric: Published clinical data is organized into clinical documents. using agreed standard document types (DICOM KOS, PDF and/or text report) Document Content Neutral: Document content is processed only by source and consumer IT systems. Standardized Registry Attributes: Queries based on meaningful attributes ensure deterministic document searches.

June 28-29, 2005IHE Interoperability Workshop 5 XDS-I Dependencies XDS-I depends on IT Infrastructure Cross- Enterprise Document Sharing (XDS) Actors are required to support XDS Document Source Document Consumer Document Registry Document Repository Documents, and metadata are specialized

June 28-29, 2005IHE Interoperability Workshop 6 XDS-I Actors / Grouping Sharing of an Extensive DICOM set Document Source shall be grouped with an Image Manager/Image Archive Sharing of a report that references selected images Document Source shall be grouped with an Image Manager/Image Archive Sharing of a report that references selected images from previously published extensive DICOM set Document Source can be grouped with a Document Consumer

June 28-29, 2005IHE Interoperability Workshop 7 XDS-I New Transactions RAD-Y1 Provide and Register Document Set ITI-14 Register Document Set ITI-16 Query Registry ITI-17 Retrieve Document ITI-18 Patient Identity Feed RAD-Y6 WADO Retrieve

June 28-29, 2005IHE Interoperability Workshop 8 XDS-I Transaction Diagram

June 28-29, 2005IHE Interoperability Workshop 9 XDS-I Required Transactions Document Consumer at least one Retrieve (DICOM C-Move) Document Source RAD-Y1 Provide and Register Document Set Document Repository nothing specific to XDS-I Document Registry nothing specific to XDS-I Image Manager / Image Archive RAD-Y6 WADO Retrieve

June 28-29, 2005IHE Interoperability Workshop 10 XDS-I Options Document Source, at least one of the following options Extensive Set of DICOM Instances PDF Report Text Report Multipart Text/PDF Report

June 28-29, 2005IHE Interoperability Workshop 11 Sharing of Extensive DICOM Instance Set

June 28-29, 2005IHE Interoperability Workshop 12 Document Registry Document Repository Manifest Reference to image 1 DICOM Manifest Reference to image 2 Reference to image 3 Manifest Clinical Encounter Clinical IT System Query Registry Manifest Retrieve Manifest Reference to image 1 DICOM Manifest Reference to image 2 Reference to image 3 Retrieve ImagesRegister Manifest Manifest

June 28-29, 2005IHE Interoperability Workshop 13 Extensive DICOM Instance Set

June 28-29, 2005IHE Interoperability Workshop 14 Sharing of Extensive DICOM Instance Set The shared Document is a manifest a Key Object Selection DICOM Instance Image Manager/Image Archive is required to ensure that the referenced images from within a published manifest are available to be retrieved Document Source is responsible for replacing a previously submitted manifest Document when a change occurs to the manifest content (eg. Change of the DICOM SOP instances refrenced wihtin the manifest)

June 28-29, 2005IHE Interoperability Workshop 15 Sharing of Imaging Report

June 28-29, 2005IHE Interoperability Workshop 16 Radiology system Report Source ….. Findings: Header : Report Type: OB / Gyn BPD... ….. Radiology Report Impressions : Gestational Age... Text Report PDF Report Text +PDF Report

June 28-29, 2005IHE Interoperability Workshop 17 Radiology system Report Source Document Registry Document Repository Report Clinical Encounter Clinical IT System Query Registry Retrieve ReportRegister Report Report ….. Findings: Header : Report Type: OB / Gyn BPD... ….. Radiology Report Impressions : Gestational Age...

June 28-29, 2005IHE Interoperability Workshop 18 Imaging Report

June 28-29, 2005IHE Interoperability Workshop 19 Sharing of Report The shared Report Document format is PDF, Text, or multipart PDF + Text A report can embed selected images in its PDF format include fully resolved hyperlinks (interactively clickable) that point to the selected images Document Source is responsible for formatting the hyperlink to reference relevant images as a DICOM WADO URI or as IHE RID Request for Document Document Source is required to ensure that image references are valid links

June 28-29, 2005IHE Interoperability Workshop 20 Linking Report to Complete Set of Images Document Repository Document Registry ManifestReport Document Entry Submission Set

June 28-29, 2005IHE Interoperability Workshop 21 Linking Report to Complete Set of Images Document Repository Document Registry Manifest Document Entry Submission Set 1 Report Document Entry Submission Set 2

June 28-29, 2005IHE Interoperability Workshop 22 Linking Report to Prior Images and Prior Report Document Repository Document Registry Manifest Document Entry Submission Set 3 Prior Manifest Document Entry Submission Set 1 Prior Report Document Entry Submission Set 2 Report Document Entry Submission Set 4

June 28-29, 2005IHE Interoperability Workshop 23 Linking Report to Selected Images Radiology system Report Source ….. Findings: Header : Report Type: OB / Gyn BPD... ….. Radiology Report Relevant Image Gestational Age... WADO URI Link to image

June 28-29, 2005IHE Interoperability Workshop 24 XDS-I Metadata eventCodeList R2 instead of Optional Code for Acquisition Modality from DCMR Context Group CID 29 and Code for Anatomic Region from DCMR Context Group CID 4 typeCode Requested Procedure Code of the Requested Procedure, to which the shared document is associated

June 28-29, 2005IHE Interoperability Workshop 25 More information…. IHE Web site: Technical Frameworks Technical Framework Supplements – Trial Implementation 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 Questions?