caBIG ® Imaging and IHE ® Potential Synergies Fred Prior and Lawrence Tarbox March, 2009

IHE ® Mission and Goals “IHE is an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information… Healthcare professionals seeking to acquire or upgrade systems need a convenient, reliable way of specifying a level of compliance to standards sufficient to achieve truly efficient interoperability. IHE Profiles provide a common language for purchasers and vendors to discuss the integration needs of healthcare sites and the integration capabilities of healthcare IT products. They offer developers a clear implementation path for communication standards supported by industry partners and carefully documented, reviewed and tested. They give purchasers a tool that reduces the complexity, cost and anxiety of implementing interoperable systems.” From and

caBIG ® Mission and Goals “The mission of caBIG ® is to develop a truly collaborative information network that accelerates the discovery of new approaches for the detection, diagnosis, treatment, and prevention of cancer, ultimately improving patient outcomes. The goals of caBIG ® are to: Connect scientists and practitioners through a shareable and interoperable infrastructure Develop standard rules and a common language to more easily share information Build or adapt tools for collecting, analyzing, integrating, and disseminating information associated with cancer research and care.”

Similar Goals, Different Domains Both intend to improve interoperability Both claim to leverage standards Both are trying to expand their importance in healthcare delivery Both utilize scenario-based specifications and modeling But … IHE ® driven more from the clinical viewpoint, caBIG ® more from the research viewpoint IHE ® driven more from a “let’s use what is already out there, and not re- invent the wheel” philosophy, while caBIG ® takes a more idealistic “let’s do it right” approach

High Level Comparison IHE ® Clinical use scenarios Web-Services plus “edge protocols” Standard models & objects (DICOM, HL7, ebXML) Standard vocabularies (DICOM, HL7, etc.) Standardized actors and transactions IHE Connectathon for testing interoperability caBIG ® Research use scenarios Grid-based (layered on top of Web-Services) Standard data structures (caDSR) Standard vocabularies (EVS) Defined program and messaging interfaces Silver and gold compatibility reviews

IHE ® Profiles – Potentially useful to caBIG ® CT – keeping systems synchronized to the same clock CPI – consistent presentation of images across systems PWF – Post-Processing Workflow ATNA – Securing communications channels and sending standardized audit messages (required by HIPAA) to a central audit repository TCE – export of DICOM data to a clinical trial, research repository, or teaching file FUS – specifies how to display fused images from registered data sets BPPC – record and enforce privacy consents from patients PSA – shared context between applications (e.g. switch patient in one applications causes all other apps to switch to that patient)

IHE ® Profiles – that compliment caBIG ® ? PIX/PDQ – HL7-based management of subject/patient identifiers Overlaps C3PR in part, but could be complimentary caBIG systems could use PIX/PDQ to access clinical MPIs as consumers caBIG systems could act a providers of patient data to PIX systems RFD – XForms-based data capture Overlaps CDS, in part Could CDS act as an RFD Form Server? XUA – cross enterprise exchange of SAML-based user authentication tokens in web services Same SAML assertion could be used, in theory, for both XUA and caGRID Could Dorian act as an assertion provider to XUA? XDS – ebXML-based cross enterprise document sharing, including – Image and –Lab variants Provides registrations services for arbitrary documents Could the XDS registry be caGrid enabled?

IHE ® Profiles – that overlap caBIG ® XDS – ebXML-based cross enterprise document sharing, including – Image and –Lab variants Overlaps Lab Viewer, among others Is an alternate mechanism (less formal) for data sharing RID – Request Information for Display An alternate (less formal) retrieve mechanism for clinical data QED – Query for Existing Data An alternate query mechanism ARI – specifies how to access radiological information Overlaps the IVI Middleware (actually used by the IVI Middleware Virtual PACs, if looked at in a certain light) An alternate query/retrieve mechanism for DICOM

IHE ® Profiles – Standardized Clinical Records Hold clinical information potentially useful to researchers. Should the content be formalized into caBIG variants? MS – Medical Summaries XPHR – Exchange of Personal Health Record Content PPHP – Pre-procedural History and Physical APS – Ante partum Care Summary FSA – Functional Status Assessments EDER – Emergency Department Encounter Record

caBIG ® tools – useful to IHE ® Could the caBIG silver and gold compatibility concepts be useful to IHE? IHE might benefit from the formalism, but Not many clinical vendors support caBIG yet, The current nature of clinical records does not lend itself to formalism at the level of caBIG yet. A DICOM Ontology and CDEs that are evolving in caBIG should be of value to IHE. IHE’s security model is insufficient, caBIG’s security model seems overly complex. Perhaps information sharing could improve both. Other touch points?

Summary There are many potential synergies between IHE ® and caBIG ® The two, in most instances could peacefully co-exist, perhaps even compliment each other, and in some cases share data and mechanisms. caBIG ® could learn lessons about practicality from IHE ® IHE ® could takes many lessons from caBIG ® on formalism