DICOM Anniversary Conference, Monday, September 22, 2003, 1:30 p.m. The History and Future of DICOM and HL7 Behlen^Fred^M^^PhD American College of Radiology Co-Chair, DICOM Working Group 20 Co-Chair, HL7 Imaging Integration SIG President, LAI Technology, Homewood, IL LAI technology 1..1

Today’s talk History –What is HL7? –Other SDOs, early connections Now –Comparative organizational structures –Connections and collaborations Future –Common information models –Information objects and services –CDA and reporting –Congruence, not coalescence

Hospital Enterprise Radiology Exam context Diagnostic Imaging in the Patient Care Process

Hospital Enterprise Radiology Exam context Results, Images Diagnostic Imaging in the Patient Care Process

Hospital Enterprise Radiology Exam context Results, Images Diagnostic Imaging in the Patient Care Process $, £, ¥, etc.

Administrative HIS/RIS... Medical Informatics Scope of DICOM Diagnostic Imaging Lab Data... Patient Bedside Monitoring Scope of Standards Scope of HL7

Disagreements in Healthcare

Origins ANSI HISPP SCAMC (AMIA) Harmonization Sessions HL7 ACR/NEMA HISPP MSDS CEN TC251 ANSI JWGDIC ISIS

DICOM-HL7 relationship 1996IMSIG formed 1999DICOM proposes joint WG 2000DICOM WG20 formed, meets in common with IMSIG (renamed IISIG) 2001DICOM & HL7 execute Memorandum of Understanding 2003HL7 Version 2.5 Order Message for Imaging (OMI)

HL7 ANSI-accredited standards development organization, formed in year old membership organization –512 organizations –862 individual members 14 Technical Committees (TCs) 17 Special Interest Groups (SIGs) 22 international affiliates A week of working group meetings 3 times annually, about 400 people attending more than 25 parallel sessions and tutorials 2119 voting members (Nov. 2001)

HL7 Special projects on drug information, adverse event reporting, genomic encoding, admin simplification, public health surveillance, practice guidelines, EHR and more Working relationships with ASTM, CEN, DICOM, ebXML, GEHR, IEEE, LOINC, OASIS, SNOMED, X12, W3C and others

WG6 DSC WGxx Board of Directors TSC TCs SIGs 1n1n n1n 1n1n Work items Ballots Charters Ballots DICOMHL7

WG6 DSC WGxx Board of Directors TSC TCs SIGs 1n1n Work items, Policy Ballots Charters Ballots IISIG WG20... DICOMHL7 Policy

Version 2.5 –Order Message for Imaging (OMI) Version 3 –Representing DICOM Procedure Model –Messages for imaging orders and reports Clinical Document Architecture (CDA) –Transforming DICOM SR into CDA documents –Diagnostic reporting in CDA format IISIG/WG20 Work Areas

OMI Message Use Case

Hierarchy in OMI message

HL7 Version 3 First HL7 standard based on explicit information model (the “RIM”) Uses automated tooling to manage complexity Components –Reference Information Model (RIM) –Clinical Document Architecture (CDA) –Version 3 Messaging Uses XML encoding High degree of compatibility with DICOM Extensive use of OIDs (cf. UIDs) Will change I.S. market as much as DICOM 3.0 changed imaging market, mostly through CDA

Communication dog

Communication dog

Patient & visit Study & acquisition Stored data

Patient & visit IODs Study & acquisition IODs Stored data IODs

Message

EntityRoleParticipationAct Message Control Document Structures

Imaging Order R-MIM Entity Act Participation Act Relationship Role CMET (Common Message Element Type)

The HL7 Clinical Document Architecture (CDA) CDA header –RIM-derived –Ground up compatibility with DICOM SR CDA Level One body –Based on subset of XHTML, fits any report type –Has image link, coded vocabulary CDA Release 2 body –Permits data representation at various levels of granularity –Passed first Committee ballot August 2003 –Member ballot March 2004

HL7 Clinical Document Architecture (CDA) Level 1 –Coded header, text content with simple formatting objects(section, paragraph, list, table) Level 2 –Standard codes for Level 1 sections Level 3 –Full structured content derived from RIM

HL7 Clinical Document Architecture (CDA) Release 2 Release 1 –Coded header, text content with simple formatting objects(section, paragraph, list, table) Release 2 –Standard codes for Level 1 sections –Full structured content derived from RIM

Release 2 CDA Release 2, Level One: –alignment with current RIM, V3 methodology –minor enhancements to CDA Header –added functionality for CDA Body Region of interest (cf. DICOM SCOORD) Release 2, Levels Two and Three –templates layered on basic XML spec Level Two: templates for headings Level Three: templates for contents –enables detailed clinical encoding

CDA Implementations National & International –PICNIC (European Union) –SCIPHOX (Germany) –HYGEIAnet/WebOnColl (Greece) –NHS South Staffordshire (United Kingdom) –Satakunta Macro Pilot (Finland) –e-Claims Supporting Document Architecture (Canada) Local & Regional –Mayo Clinic (USA) –Buenos Aires project (Argentina) –Dalhousie U, QEII Health Sci Ctr (Canada)

HL7 Templates Joint project of Templates SIG, Structured Documents TC, Conformance SIG Open template registry/repository –will contain normative and non-normative templates Tools for generating and validating templates will be developed This will take a while

A Number of Connections WG20 / IISIG  Other HL7 groups –Technical Committees Orders & Observations Vocabulary Structured Documents Laboratory Automation and Point of Care Testing Patient Care Control/Query –Special Interest Groups Conformance Electronic Health Records (EHR) Security & Accountability Templates

More Connections WG14  SASIG  NEMA SPC  IHE IHE  Conformance SIG DICOM  HL7 venues –WG10  TC215/WG2 –WADO  TC215/WG2 Also WADO  Structured Documents TC

A Rewarding Partnership No big turf issues –DICOM doesn’t want to define enterprise communications –HL7 has no ambition or bandwidth to model specialty domain detail Each can learn from the other –DICOM experience with persistent objects –HL7 experience with modeling tools HL7 meetings are a good gathering place