1. Imaging Integration V3 Ballot Outline Helmut Koenig DICOM WG20 / HL7 II SIG Atlanta WG Meeting September 2004

2. V3 Objectives Use of imaging-specific rather than generic HL7 Orders and Observations Messages Foster cross-departmental workflow between imaging and other clinical specialties for synchronization of multi- disciplinary provision of care and access to relevant information Enable the image-enhanced EHR

3. V3 Scope The imaging integration domain comprises the artifacts that are needed to support messaging between clinical, departmental and imaging information systems or image archive management systems. Imaging covers signals acquired by imaging modalities, that is pixel data, image header meta-data and associated reports. Reports may reference a variety of relevant data, such as selected images, waveforms and prior reports. Imaging integration primarily supports the exchange of data related to imaging orders and observations as well as data required to synchronize the cross-departmental workflow.

4. What`s there Draft DMIM Draft RMIMs –Imaging Request (Placer Order Mgmt.) –Imaging Promise (Filler Order Mgmt.) –Imaging Schedule (Procedure Scheduled) –Imaging Event

5. Next Steps Update Storyboards Being in sync with / extend the: –OO Dynamic Model (Interactions) –OO Generic Orders and Observations Messages –CMET development –Clinical Statement Model

6. Image Integration Storyboards References to IHE profiles, transactions and actors where appropriate Potential IHE transition from HL7 V2.x to V3 messages Re-use of IHE work References to the DICOM standard Re-use of DICOM concepts

7. II Imaging Request Relevant Clinical Information from both information systems (HL7) and the imaging domain (DICOM) including clinical question for verification of clinical indication (radiation inducing diagnostic imaging/ imaging procedures) Use of references to DICOM composite objects within HL7 Optional consent for (minimal) invasive proce- dures Imaging specific alerts

8. II Imaging Promise Based on the result of verification of the clinical indication, the imaging promise is sent back to the requesting physician(s) Including evidence (relevant information) that justifies the appropriateness of the intent for the diagnostic imaging exam / (minimal) invasive procedure Reference to the original order is provided for tracking potential modifications or reason for rejecting the initial order

9. II Imaging Schedule Based on the verified indication: Work steps and action items (optionally based on protocols) are scheduled For a group of / individual modalities (Mapping to SPS, MWL Query Matching and Return Keys) For a group of / individual workplaces (Mapping to GP-SPS, General Purpose WL Query Matching and Return Keys) Unification of Worklists which may include references to DICOM composite as well as HL7 Structured Document Objects

10. II Imaging Event (1) Work steps and action items (optionally based on protocols) are performed References to the scheduled worksteps are provided in order to enable tracking of modifications Worksteps being relevant for related activities within and outside the imaging department may optionally be included in the message and subsequently used to populate worklists Steps performed at modality which has an associated location (Mapping to MPPS, MWL) Steps performed at workplace which has an associated location (Mapping to GPPPS, GPWL) Unification of Worklists which may include references to DICOM composite as well as HL7 Structured Document Objects

11. II Imaging Event (2) Unification of Worklists which may include references to DICOM composite as well as HL7 Structured Document Objects Observation Events are created, such as: Images (DICOM Study, Series, Instance or Significant Images by use of Key Object Selection) and associated Grayscale Softcopy Presentation States Reports (DICOM SR) which may subsequently be transformed to equivalent CDA documents for distribution Convey observation data by reference or by value