1. IHE Cardiology Displayable Report (DRPT) Profile Harry Solomon, Tom Dolan February 16, 2005 Rev 0.3

2. IHE Cardiology Page 2 Displayable Report Problem Statement PDF is a required “displayable report” format for broad distribution of clinical documents (e.g., as used in the ITI RID Profile). In fact, this is perhaps the most significant format for reports since (unlike DICOM SR or HL7 CDA) it maintains the exact report display presentation. However, there is no IHE profile associated with production of such reports. This proposed IHE integration profile will be used to manage the production of outbound reports from the imaging department in PDF format, and their transmission to an Enterprise Report Repository. Within the department they will be managed and stored with the other procedure evidence.

3. IHE Cardiology Page 3 Displayable Report Actor-Transaction Diagram  [24]: Report Submission [28]: Structured Report Export   [25]: Report Issuing Report Creator  ITI-11: Retrieve Specific Information for Display  ITI-12: Retrieve Document for Display  [26]: Query Reports  [27]: Retrieve Reports Report Repository Report Reader Information Source Report Manager Enterprise Report Repository Display Image Display Image Archive  RAD-14: Query Images CARD-4, RAD- 16: Retrieve Images RAD-44: Query Evidence Documents RAD-45: Retrieve Evidence Documents    Part of: Cath Workflow Echo Workflow Stress Workflow Evidence Documents Retrieve Information for Display Comparable SINR transaction identifiers noted and relationship to some other profiles’ actors

4. IHE Cardiology Page 4 Radiology (SINR Profile) Actors Report Creator – A system that generates and transmits draft (and optionally, final) diagnostic reports, presenting them as DICOM Structured Reporting Objects. It may also retrieve worklist entries for reporting steps from the Report Manager and provide notification of completion of the step, allowing the enterprise to track the status of an awaited report. Report Manager – A system that provides management and short-term storage of DICOM Structured Report objects during the reporting process then distributes text or structured reports to report repositories. It also manages the worklists and status of reporting. Report Reader – A system that can query/retrieve and view reports presented as DICOM Structured Reporting objects. Report Repository – A system that provides long-term storage of diagnostic reports and their retrieval as DICOM Structured Reporting Objects. Enterprise Report Repository – A system that receives Structured Report Export Transactions from the Report Manager and stores them. Strikethroughs indicate changes to generalize the Actor definitions for use in this Profile.

5. IHE Cardiology Page 5 Radiology (SINR Profile) Transactions 24. Report Submission – A Report Creator sends a draft or final diagnostic report to the Report Manager. 25. Report Issuing – A Report Manager sends a draft or final diagnostic report to the Report Repository. 26. Query Reports – A Report Reader provides a set of criteria to select the list of entries representing diagnostic reports by patient, study, series, or instance known by the Report Repository or External Report Repository Access. 27. Retrieve Reports – A Report Reader requests and retrieves a diagnostic report from the Report Repository or External Report Repository Access. 28. Structured Report Export – A Report Manager composes an HL7 Result transaction by mapping from DICOM SR and transmits it to the Enterprise Report Repository for storage. These transactions will be the basis for new Transactions defined for use in this Profile. Strikethroughs indicate changes to generalize the Transaction definitions for use in this Profile.

6. IHE Cardiology Page 6 Displayable Report Transactions Report Submission – PDF encapsulated in a single OBX segment in an HL7 ORU message. Needs Requested Procedure / Study UID in HL7 message. Rules on PDF content (as we did with ECG content), e.g., for patient and study ID, physician ID, image links, and completion/verification status? Report Issuing – PDF encapsulated in DICOM per Sup104. Needs rules on title as both free text and coded concept in DICOM wrapper. Rules on PDF content? Query Reports – DICOM Query; Instance level keys include title/coded concept. Retrieve Reports – DICOM Retrieve Encapsulated PDF. Structured Report Export – PDF encapsulated in HL7 ORU.

7. IHE Cardiology Page 7 Displayable Report Profile Scenario A cardiologist reviews the observations and evidence created during an exam. She prepares a report formatted as a PDF (on the Report Creator workstation), and submits it in an HL7 message to the cardiology department Information System (Report Manager actor). The Information System encapsulates the PDF report in a DICOM wrapper and stores it in the cardiology department PACS (Report Repository); it also forwards it in an HL7 message to the hospital’s report repository for distribution. Within the department, access to the full procedure data set thus includes the PDF report (as a DICOM object), as well as the images and measurements. Outside the department, the report may be retrieved using an HTTP query retrieving the PDF (through the ITI RID Profile).

8. IHE Cardiology Page 8 Relationship to Workflow Profiles Exam data being reported on is produced through the Cath Workflow, Echo Workflow, Stress Workflow, or Evidence Documents Profiles, or the Radiology Scheduled Workflow (SWF) Profile. This Profile is similar to the Simple Imaging and Numeric (SINR) Profile, and uses the same Actors. However, SINR is based on the production of DICOM SR objects as the intra-departmental report format, rather than PDF. This Profile does not supersede the SINR Profile, which may be used for reports where computer-processable discrete measurements and image references are needed. Both profiles may co-exist within the same set of equipment. Reporting workflow management (e.g., echo overread list) may be implemented using the Reporting Workflow (RWF) Profile, which is based on DICOM General Purpose Worklist/Performed Procedure Step (GP-WL / GP-PPS) Submission of the final report enables the DSS/OF actor to notify the Order Placer system of completed status (transaction RAD-3 in the Cath, Echo, or SWF Profiles).

9. IHE Cardiology Page 9 Relationship to IT Infrastructure Profiles Enterprise-wide distribution of PDF reports, from either the departmental Report Repository or the Enterprise Report Repository, would use the Retrieve Information for Display (RID) Profile Cross-enterprise distribution of PDF reports would use the Cross- enterprise Document Sharing (XDS) Profile The Report Creator may also use patient-related documents from various Repositories accessed using RID and XDS Reporting clinician log-in to the Report Creator system may be facilitated through the Enterprise User Authentication (EUA) Profile Identification of the reporting clinician may use an institution-standard form provided through the Personnel White Pages (PWP) Profile Object retrieve access to the Report Repository may be recorded for in the Audit Trail and Node Access (ATNA) Profile

10. IHE Cardiology Page 10 In Scope / Out of Scope The problem addressed is the preparation, forwarding, and storage of PDF formatted reports. FeatureIn/Out Preparation of PDF formatted reports on independent workstationIn Workflow for scheduling/statusing report preparationOut (RWF) Forwarding of PDF formatted reports encapsulated in an HL7 messageIn Departmental storage of PDF formatted reports encapsulated in DICOMIn Query/Retrieve of PDF formatted reports encapsulated in DICOMIn Preparation of CDA or HTML formatted reportsOut PDF formatted reports encapsulated in CDAOut Forwarding of reports by reference as URI linksOut Query/Retrieve of PDF formatted reports from enterprise repositoryOut (RID) Note: list functionality especially at borders of what is included/excluded – i.e., included features that could reasonably be descoped by the Technical Committee, or excluded features that could be included

11. IHE Cardiology Page 11 Phased Approach Not Applicable

12. IHE Cardiology Page 12 Open Issues 1.Scope (In/Out chart) 2.What is format of Report Submission transaction, and can it convey incomplete report? How does such a report become complete? 3.How does this work with HL7 observations in Stress Workflow? 4.Does Cardiology Technical Framework need to incorporate SINR and RWF profiles by reference (as is proposed for ED profile)? Allows demonstration of managed reporting workflow using DICOM GP-WL and DICOM SR (if any participants want to do that). Responds to Planning Committee Echo year 2 proposal