1. IHE Workshop – June 2006What IHE Delivers 1 Kevin O’Donnell Toshiba Medical Systems Evidence Documents Profile

2. IHE Workshop – June 2006 2 Evidence Documents Problem Cardiology is measurement intensive More and more modalities and workstations provide digital measurements More and more sites are doing electronic reporting  … to improve efficiency, turnaround time and reduce errors Current “state of the art”? -> Screen dump a paper report  Introduces multiple unnecessary error points:  A series of numbers that could be misread, misspoken, misheard and mistyped  Introduces additional unnecessary effort  Introduces additional unnecessary delay

3. IHE Workshop – June 2006 3 Evidence Documents Problem Other popular kludges  Measurements handwritten onto a worksheet which is later dictated / transcribed  Measurements output to a printer port and intercepted by an application that scrapes the values  Measurements recorded as a screen capture then later OCR (optical character recognition) extracts numbers and label strings … brittle solutions

4. IHE Workshop – June 2006 4 Evidence Documents Scope Covers creation, storage and retrieval of evidence documents Evidence documents contain coded observations such as measurements, procedure logs, CAD results, etc. Evidence Documents are not Diagnostic Reports Evidence Documents are:  Inputs to the interpretation process (like images)  Generally created, managed and used entirely inside Cardiology/Radiology Dept Diagnostic Reports are:  Outputs from the interpretation process  Generally created inside Cardiology/Radiology and distributed outside

5. IHE Workshop – June 2006 5 Evidence Documents Scope Creation:  Generally Acquisition Modality or workstation (aka Evidence Creator)  Generally created during acquisition or post-processing workflow  Creator supports appropriate SR objects/templates Storage:  Stored and Committed to “Image” Manager/Archive Retrieval:  Retrieved by “Image Display”  May be retrieved for presentation/interpretation with images, for further processing, and/or for insertion into electronic reports  Image Display may be grouped with a Report Creator

6. IHE Workshop – June 2006 6 Evidence Documents Use Case Electronic Distribution of measurements, CAD and other observations Evidence Document Stored Storage Commitment Query / Retrieve ….. Findings: Image Refs.: Header : Report Type: Echo EF ….. WallMotion

7. IHE Workshop – June 2006 7 Interpretation Simple Image & Numeric Report Evidence Documents ….. Findings: Image Refs.: Header : Report Type: Echo EF Wall… ….. Cardiology Report Impressions :... Key Image Notes ….. Findings: Image Refs.: Header : Report Type: Echo EF ….. WallMotion

8. IHE Workshop – June 2006 8 Evidence Documents Image References Echocardiography Measurement Patient: Doe, John Technologist: der Payd, N Measurements: Mitral valve diameter 3.1cm - shown in image at [ ] Ventricular length, diastolic 5.97 cm - shown in image at [ ] Ventricular volume, diastolic 14.1 ml - inferred from [ ] - inferred from VLZ algorithm

9. IHE Workshop – June 2006 9 Evidence Documents Value proposition Measurements are managed in same study folder as images Data is structured and uses coded concepts and vocabulary Coded data can be searched, processed, databased (locally, national registry), … Avoids detour through “paper-space”  extra handling, delay and potential loss of paper  additional effort and errors

10. IHE Workshop – June 2006 10 Evidence Documents Technical Basis Based on:  DICOM Structured Report (SR) Objects  Storage Commitment  Query/Retrieve Addresses creation/distribution of the content Scheduling and progress reporting could easily be supported by also implementing an appropriate IHE workflow profile

11. IHE Workshop – June 2006 11 Evidence Documents Cath Evidence Option Acquisition Modalities / Evidence Creators: Shall support one or more of the following DICOM Objects:  Enhanced SR  Comprehensive SR  Procedure Log Shall use one or more of the following templates:  3001 Procedure Log  3202 Ventricular Analysis  3213 Quantitative Arterial Analysis  3250 Intravascular Ultrasound  3500 Hemodynamics Image Displays: Shall unambiguously render ALL of the above  Includes providing visual emphasis for measurements flagged “abnormal”  Support of the templates is implicit in support of the DICOM Objects  Displays may optimize display for the templates

12. IHE Workshop – June 2006 12 Evidence Documents Echo Evidence Option Acquisition Modalities / Evidence Creators: Shall support one or more of the following DICOM Objects:  Enhanced SR  Comprehensive SR Shall use one or more of the following templates:  5100 Vascular Ultrasound  5200 Echocardiography Image Displays: Shall unambiguously render ALL of the above  Includes providing visual emphasis for measurements flagged “abnormal”  Support of the templates is implicit in support of the DICOM Objects  Displays may optimize display for the templates

13. IHE Workshop – June 2006 13 Evidence Documents Cath & Echo Evidence Options Specific guidance provided on Completion Flag (0040,A491), E.g.:  “Complete” requires the contents be attested/verified by an identified user  “Complete” means content includes all significant measurements in the scope of the root Concept Name of the document  A Requested Procedure may have multiple documents, each covering a separate scope/topic Specific guidance provided on Normality Flag (Template 3100)  Allows flagging of measurements as Abnormal (high, low)

14. IHE Workshop – June 2006 14 Evidence Documents Other Templates:  3900 CT/MR Cardiovascular Analysis  4000 Mammography CAD  4100 Chest CAD  4200 Breast Imaging Report  5000 OB-Gyn Ultrasound Report

15. IHE Workshop – June 2006 15 Example Transaction Flow

16. IHE Workshop – June 2006 16