February 8, 2005IHE Europe Educational Event 1 Integrating the Healthcare Enterprise Key Image Notes Simple Image & Numeric Report Evidence Documents Sanjay Jain Co-Chair, Radiology Planning Committee

February 8, 2005IHE Europe Educational Event 2 Value Proposition Share diagnosis, reports and images Standard mechanism to communicate with the referring physicians Enable Automated handling based on coded data  E.g. Routing  Mammo Follow-up and checking  Clinical trials Avoid dependence only on memory Paper, audio.. Data mining

February 8, 2005IHE Europe Educational Event 3 Don’t Call Us, We’ll Call You “Dave, you read that 3000 slice MR study last night. Can you highlight the 5 most important images for me”  Thinking… You”, says You “Dr. Channin, I just reviewed 40 cases and marked my questions on yellow stickies. Can you review those” Tech to radiologist: “The patient wouldn’t hold still” The solution is……

February 8, 2005IHE Europe Educational Event 4 IHE Radiology Integration Profiles Patient Info. Recon- ciliation Access to Radiology Information Consistent Present- ation of Images Basic Security - Evidence Docs Simple Image & Numeric Reports Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting Scheduled Workflow Portable Data for Imaging NM Image Key Image Notes

February 8, 2005IHE Europe Educational Event 5 for referring physician Here you can see the renal osteopathy. For teaching Fibroosteoclasia

February 8, 2005IHE Europe Educational Event 6 Different notes on different images Same note on different images for referring physician Here you can see the renal rupture. Note1 for referring physician This is the hematoma. Note2 for refering physician Here you can see the renal rupture. Note1 for refering physician This is the hematoma. Note2 for refering physician Hematoma everywhere Note3 for refering physician Hematoma everywhere Note3 for refering physician Hematoma everywhere Note3 for refering physician Hematoma everywhere Note3 for referring physician Hematoma everywhere Note3

February 8, 2005IHE Europe Educational Event 7 Key Image Notes Titles are Coded Defined by DICOM Supplement 59. May be extended The note title defines the semantics of the reason of significance. Key Image Notes can be queried by code. The user comments are meant to be informal. Codes Of Interest Rejected for Quality Reasons For Referring Provider For Surgery For Teaching For Conference For Therapy For Patient For Peer Review For Research Quality Issue Reporting (CP in ballot)

February 8, 2005IHE Europe Educational Event 8 Key Image Notes There is more to teamwork than images and reports With IHE, it is possible to attach « electronic post-it™ » to images to increase informal but critical communication between:  The Technologist and the Radiologist about specific examination events  The Radiologist and the Technologist about image quality issues  The Radiologist and other department clinicians (surgeon, orthopedist,..)  The Radiologist and collegues about selecting images for conferences  The Radiologist to the Referring Provider, …..etc. Query for the Images/Studies using the codes This IHE Integration Profile is the cost effective solution (increases radiology and overall efficiency)

February 8, 2005IHE Europe Educational Event 9 Evidence Documents ….. Findings: Image Refs.: Header : Report Type: OB / Gyn BPD... ….. Evidence Document Stored Storage Commitment Query / Retrieve

February 8, 2005IHE Europe Educational Event 10 Evidence Documents Measurements and coded data  DICOM SR document Created by either Acquisition Modality or Evidence Creator Produced during acquisition or post- processing workflows Interpreted along with the images

February 8, 2005IHE Europe Educational Event 11 Evidence Documents Examples Mammography CAD Chest CAD OB-Gyn Ultrasound Measurements Vascular Ultrasound Measurements Vascular Intervention Results Echocardiography Measurements

February 8, 2005IHE Europe Educational Event 12 Interpretation ….. Findings: Image Refs.: Header : Report Type: OB / Gyn BPD... ….. Simple Image & Numeric Report Evidence Documents ….. Findings: Image Refs.: Header : Report Type: OB / Gyn BPD... ….. Radiology Report Impressions : Gestational Age... Key Image Notes

February 8, 2005IHE Europe Educational Event 13 Can You Make A Report Like This? Institution Identification Patient Identification Study Identification Technique Identification Discussion The liver is normal. There is a focal area of decreased attenuation adjacent to the falciform ligt., likely representing focal fat (image 22). The spleen, both kidneys, the … are normal. Impression CT of the abdomen within normal limits Signature The solution is……

February 8, 2005IHE Europe Educational Event 14 (We can’t either). What about? Discussion Comparison is made to the prior study of 4/11/99. The left paratracheal lymph node (image 8, image 11) now measures 2.5x2.7x3.1 cm increasing from 2.0x2.1x2.6 previously. No other mediastinal, upper abdominal or axillary adenopathy is identified. No focal pulmonary lesions are seen. The yadda, yadda, yadda are normal. Impression Worsening L Paratracheal adenopathy. Signature

February 8, 2005IHE Europe Educational Event 15 IHE Radiology Integration Profiles Patient Info. Recon- ciliation Access to Radiology Information Consistent Present- ation of Images Basic Security - Evidence Docs Key Image Notes Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting Scheduled Workflow Portable Data for Imaging NM Image Simple Image & Numeric Reports

February 8, 2005IHE Europe Educational Event 16 Simple Image and Numeric Reports

February 8, 2005IHE Europe Educational Event 17 Simple Image & Numeric Reports Based on DICOM SRBased on DICOM SR Allows to include without transcription: - measurements - image links - structured contentAllows to include without transcription: - measurements - image links - structured content Integrated with the imaging workflowIntegrated with the imaging workflow Friendly to XML implementationsFriendly to XML implementations Easy to export to the EPR (HL7)Easy to export to the EPR (HL7)

February 8, 2005IHE Europe Educational Event 18 Pattern – Simple Image Report Minimal Structure : Coded Title and HeadingsMinimal Structure : Coded Title and Headings Full image links from specific sections of reportFull image links from specific sections of report Observation Context (who, what, when) may be section specificObservation Context (who, what, when) may be section specific

February 8, 2005IHE Europe Educational Event 19 Pattern – Simple Image & Numeric Report Simply adds Measurements to Simple Image Reports

February 8, 2005IHE Europe Educational Event 20 An Illustration Chest, PA & Lateral (GCS,T78) Chest, PA & Lateral (GCS,T78) Procedure PA and Lateral radiographs were ……. Conclusions Possible Mass (ICD,XXX) Findings The PA demonstrates... A small opacity is visible in the base of lung in lateral view. Image 32 CT recommended. Dr Andrew Smith ……. George Jones …...

February 8, 2005IHE Europe Educational Event 21 Simple Image and Numeric Report Reports’ content is more than words….. SINR is the Output of Interpretation, while Evidence documents are Input for Interpretation With IHE, it is possible to add value to reports/preliminary reports by organizing content This IHE Integration Profile is the cost effective solution to sharing reports and enabling content processing applications (increases radiology efficiency)

February 8, 2005IHE Europe Educational Event 22 More information…. IHE Web sites: Technical Frameworks: ITI V1.0, RAD V5.5, LAB V1.0 Technical Framework Supplements - Trial Implementation May 2004: Radiology August 2004: Cardiology, IT Infrastructure 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?