Clinical Document Architecture Open Standards-based EPR Incorporating Radiology Michael LaRocca

Agenda Why are XDS, XDR, and CDA a perfect match? How do XDS, XDR, and CDA come together to achieve an Electronic Patient Record? How do RIS concepts and metadata map to XDS, XDR, and CDA?

Roles of CDA, XDS, and XDR Clinical ContentCommunity SharingDirect Exchange CDAXDSXDR Patient Summary Referral Summary Discharge Summary Lab Report More… Document Submission Document Storage Document Registration Document Sharing Document Submission Document Receipt

Goals of CDA CDA: Goals Give priority to delivery of patient care. Allow cost-effective implementation across as wide a spectrum of systems as possible. Support exchange of human-readable documents between users, including those with different levels of technical sophistication. Promote longevity of all information encoded according to this architecture. Enable a wide range of post-exchange processing applications. Promote exchange that is independent of the underlying transfer or storage mechanism. Prepare the design reasonably quickly. Enable policy-makers to control their own information requirements without an extension to this specification.

Overlapping Goals of CDA, XDS, and XDR CDA, XDS, and XDR: Overlapping Goals Give priority to delivery of patient care. Allow cost-effective implementation across as wide a spectrum of systems as possible. Support exchange of human-readable documents between users, including those with different levels of technical sophistication. Promote longevity of all information encoded according to this architecture. Enable a wide range of post-exchange processing applications. Promote exchange that is independent of the underlying transfer or storage mechanism. Enable policy-makers to control their own information requirements without an extension to this specification.

Agenda Why are XDS, XDR, and CDA a perfect match? How do XDS, XDR, and CDA come together to achieve an Electronic Patient Record? How do RIS concepts and metadata map to XDS, XDR, and CDA?

IHE Core Services: Patient Identification via PIX(v3) PHRImage Viewer Clinician Portal EHR Document Consumers Registration System Lab System Radiology System EMR Document Sources PIX(v3) / PDQ(v3) Manager Local ID: ABCLocal ID: DEF Global ID: XYZ Local ID: GHILocal ID: JKL XDSb Document Registry Global ID: XYZ

IHE Core Services: Document Submission via XDSb PHRImage Viewer Clinician Portal EHR Document Consumers Registration System Lab System Radiology System EMR Document Sources PIX(v3) / PDQ(v3) Manager Local ID: ABCLocal ID: DEF Global ID: XYZ Local ID: GHILocal ID: JKL XDSb Document Registry Global ID: XYZ XDSb Document Repository Repository ID: 123 Document ID: 1 Content XDSb Document Repository Repository ID: 456 Document ID: 2 Content Document ID: 3 Content Document 1Document 2 Document 3

IHE Core Services: Document Consumption via XDSb PHRImage Viewer Clinician Portal EHR Document Consumers Registration System Lab System Radiology System EMR Document Sources PIX(v3) / PDQ(v3) Manager Local ID: ABCLocal ID: DEF Global ID: XYZ Local ID: GHILocal ID: JKL XDSb Document Registry Global ID: XYZ XDSb Document Repository Repository ID: 123 Document ID: 1 Content XDSb Document Repository Repository ID: 456 Document ID: 2 Content Document ID: 3 Content Document 1Document 2 Document 3

IHE Core Services: Cross Community Access via XCA PHRImage Viewer Clinician Portal EHR Document Consumers Registration System Lab System Radiology System EMR Document Sources PIX(v3) / PDQ(v3) Manager Local ID: ABCLocal ID: DEF Global ID: XYZ Local ID: GHILocal ID: JKL XDSb Document Registry Global ID: XYZ XDSb Document Repository Repository ID: 123 Document ID: 1 Content XDSb Document Repository Repository ID: 456 Document ID: 2 Content Document ID: 3 Content Document 1Document 2 Document 3 XCA Initiating Gateway

IHE Core Services: Document Exchange via XDR Point-to-Point SourceDestination Point-to-Point through intermediary components SourceDestination Source HISP Destination HISP

Agenda Why are XDS, XDR, and CDA a perfect match? How do XDS, XDR, and CDA come together to achieve an Electronic Patient Record? How do RIS concepts and metadata map to XDS, XDR, and CDA?

Metadata Mapping: RIS to CDA to XDS and/or XDR CategoryRISCDAXDS / XDR Patient InformationNamenamesourcePatientInfo Date of BirthbirthTimesourcePatientInfo SexadministrativeGendersourcePatientInfo AddressaddresssourcePatientInfo Patient NumberidsourcePatientId National NumberidpatientId Patient Classencompassing Encounter Not Represented

Metadata Mapping: RIS to CDA to XDS and/or XDR CategoryRISCDAXDS / XDR CreatorPerson Nameauthor Grade / FunctionauthorauthorRole Contact NumberauthorsourcePatientInfo Responsible TeamlegalAuthenticator Reporting SourceauthorauthorInstitution ConsumerRecipient NameintendedRecipient Grade / FunctionNot Represented Contact NumberintendedRecipientNot Represented Recipient TeamintendedRecipient Recipient TargetintendedRecipient

Clinical Mapping: RIS to CDA CategoryRISCDA HeaderReport TypeClinicalDocument/code Accession Number ClinicalDocument/inFulfillmentOf/…order/ id DICOM Objects Section Studyact Seriesact/entryRelationship/act Service-Object Pair (SOP) Instance act/entryRelationship/act/entryRelationshi p/observation Findings SectionFindingstext (narrative) Measuremententry/observation Measurement (WADO) entry/observation /entryRelationship/observation Conclusions SectionConclusionstext (narrative)

DICOM SR “Basic Diagnostic Imaging Report” in CDA

Clinical Document Architecture Open Standards-based EPR Incorporating Radiology Michael LaRocca