1. Evolution of Image Sharing: A long and winding road Elliot Silver, M.Sc. Senior Standards Analyst

2. Evolution of Image Sharing Problem Statement Radiology imaging has been independent of the primary electronic patient record. However, clinicians increasingly need access to the patient’s longitudinal record including clinical documents as well as imaging.

3. Evolution of Image Sharing Focus DICOM XDS-I DICOMweb FHIR A Way Forward

4. Evolution of Image Sharing DICOM ® For medical imaging, the standard is DICOM (Digital Imaging and Communications in Medicine) –Specialized file formats and network protocols for storing, querying, retrieving, and managing images and imaging workflows –Targeted departmental imaging needs –Requires DICOM-aware viewing systems –Poor “ad hoc” viewing/sharing capabilities –Largely independent of the HIS or EHR DICOM is a registered trademark of the National Electrical Manufacturers Association

5. Evolution of Image Sharing Classical DICOM sharing Print and Scan –Source prints films; recipient may scan DICOM media –CD, USB, etc. Reference Web Viewers –DICOM-aware web applications, typically provided by PACS vendor Point-to-Point Sending –Proprietary solutions to send imaging over the Internet

6. Evolution of Image Sharing IHE Cross-Enterprise Document Sharing for Imaging (XDS-I) Based on IHE’s Cross-Enterprise Document Sharing (XDS) profile Images can be retrieved over web as JPEG, etc. Allows imaging to easily cross organizational boundaries Still requires consumer to be DICOM aware

7. Evolution of Image Sharing DICOMweb Additional DICOM capabilities based on popular RESTful paradigm DICOM object retrieve DICOM object storage DICOM object query DICOM workflow WADO-RSSTOW-RSQIDO-RSUPS-RS

8. Evolution of Image Sharing HL7 ® FHIR ® (Fast Healthcare Interoperable Resources) Next generation standard from HL7 Nearing second draft release (DSTU2); targeting normative release in 2017 Modern, web-friendly design; focus on ease of implementation RESTful (plus others) model Feeling in community that FHIR will supplant HL7 v2 and v3 within 5-10 years HL7 and FHIR are registered trademarks of Health Level Seven International.

9. Evolution of Image Sharing HL7 FHIR Imaging Resources Resources to represent key DICOM study information (including image references) and selected images Image references are (WADO-RS) URLs –No need to know DICOM to display images, etc. Imaging resources like other FHIR resources –No need to know DICOM query or Key Object Selection file structure to find images Allows access to imaging by non-imaging aware applications

10. Evolution of Image Sharing Imaging-Integrated Health Record Influence How will integrating imaging influence care delivery cost and quality? Access Who will access this integrated record, and where? Integrate What does an integrated record look like?

11. Evolution of Image Sharing The Road Ahead The evolution of FHIR and DICOMweb are giving us a map. We are at a critical inflection point. As a community, we can define the road we take to integrated imaging.

12. Thank You www.mckesson.com Elliot Silver, M.Sc. Senior Standards Analyst