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DICOM Anniversary Conference, Monday, September 22, 2003, 1:30 p.m. The History and Future of DICOM and HL7

Behlen^Fred^M^^PhD American College of Radiology Co-Chair, DICOM Working Group 20 Co-Chair, HL7 Imaging Integration SIG President, LAI Technology, Homewood, IL. DICOM Anniversary Conference, Monday, September 22, 2003, 1:30 p.m. The History and Future of DICOM and HL7. 1..1 1..1.

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DICOM Anniversary Conference, Monday, September 22, 2003, 1:30 p.m. The History and Future of DICOM and HL7

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  1. Behlen^Fred^M^^PhD American College of Radiology Co-Chair, DICOM Working Group 20 Co-Chair, HL7 Imaging Integration SIG President, LAI Technology, Homewood, IL DICOM Anniversary Conference, Monday, September 22, 2003, 1:30 p.m.The History and Future ofDICOM and HL7 1..1 1..1 LAItechnology

  2. History What is HL7? Other SDOs, early connections Now Comparative organizational structures Connections and collaborations Future Common information models Information objects and services CDA and reporting Congruence, not coalescence Today’s talk

  3. Diagnostic Imaging in the Patient Care Process Hospital Enterprise Exam context Radiology

  4. Diagnostic Imaging in the Patient Care Process Hospital Enterprise Exam context Results, Images Radiology

  5. Diagnostic Imaging in the Patient Care Process Hospital Enterprise Exam context Results, Images Radiology $, £, ¥, etc.

  6. Scope of Standards Scope ofHL7 Medical Informatics . . . PatientBedsideMonitoring Administrative HIS/RIS Lab Data . . . DiagnosticImaging Scope ofDICOM

  7. Disagreements in Healthcare

  8. Origins ANSI HISPP SCAMC (AMIA) Harmonization Sessions HL7 ANSI JWGDIC ACR/NEMA ISIS HISPP MSDS CEN TC251

  9. 1996 IMSIG formed 1999 DICOM proposes joint WG 2000 DICOM WG20 formed, meets in common with IMSIG (renamed IISIG) 2001 DICOM & HL7 execute Memorandum of Understanding 2003 HL7 Version 2.5 Order Message for Imaging (OMI) DICOM-HL7 relationship

  10. ANSI-accredited standards development organization, formed in 1987 16+ year old membership organization 512 organizations 862 individual members 14 Technical Committees (TCs) 17 Special Interest Groups (SIGs) 22 international affiliates A week of working group meetings 3 times annually, about 400 people attending more than 25 parallel sessions and tutorials HL7 2119 voting members(Nov. 2001)

  11. Special projects on drug information, adverse event reporting, genomic encoding, admin simplification, public health surveillance, practice guidelines, EHR and more Working relationships with ASTM, CEN, DICOM, ebXML, GEHR, IEEE, LOINC, OASIS, SNOMED, X12, W3C and others HL7

  12. DICOM HL7 Board ofDirectors DSC 1 1 Work items TSC 1 1 Charters 1 n WG6 Ballots TCs Ballots 1 n 1 n WGxx SIGs

  13. DICOM HL7 Board ofDirectors Policy DSC 1 1 Work items, Policy TSC 1 1 Charters 1 n WG6 Ballots TCs Ballots WG20 WGxx . . . IISIG . . . SIGs

  14. Version 2.5 Order Message for Imaging (OMI) Version 3 Representing DICOM Procedure Model Messages for imaging orders and reports Clinical Document Architecture (CDA) Transforming DICOM SR into CDA documents Diagnostic reporting in CDA format IISIG/WG20 Work Areas

  15. OMI Message Use Case

  16. Hierarchy in OMI message

  17. HL7 Version 3 • First HL7 standard based on explicit information model (the “RIM”) • Uses automated tooling to manage complexity • Components • Reference Information Model (RIM) • Clinical Document Architecture (CDA) • Version 3 Messaging • Uses XML encoding • High degree of compatibility with DICOM • Extensive use of OIDs (cf. UIDs) • Will change I.S. market as much as DICOM 3.0 changed imaging market, mostly through CDA

  18. Communication dog

  19. Communication dog

  20. Patient& visit Study &acquisition Storeddata

  21. Patient& visitIODs Study &acquisitionIODs StoreddataIODs

  22. Message Message Message Message Message Message Message Message

  23. Entity Role Participation Act Document Structures Message Control

  24. Imaging Order R-MIM Act Participation Role CMET (Common Message Element Type) Act Relationship Entity

  25. CDA header RIM-derived Ground up compatibility with DICOM SR CDA Level One body Based on subset of XHTML, fits any report type Has image link, coded vocabulary CDA Release 2 body Permits data representation at various levels of granularity Passed first Committee ballot August 2003 Member ballot March 2004 The HL7 Clinical Document Architecture (CDA)

  26. Level 1 Coded header, text content with simple formatting objects(section, paragraph, list, table) Level 2 Standard codes for Level 1 sections Level 3 Full structured content derived from RIM HL7 Clinical Document Architecture (CDA)

  27. Release 1 Coded header, text content with simple formatting objects(section, paragraph, list, table) Release 2 Standard codes for Level 1 sections Full structured content derived from RIM HL7 Clinical Document Architecture (CDA) Release 2

  28. Release 2, Level One: alignment with current RIM, V3 methodology minor enhancements to CDA Header added functionality for CDA Body Region of interest (cf. DICOM SCOORD) Release 2, Levels Two and Three templates layered on basic XML spec Level Two: templates for headings Level Three: templates for contents enables detailed clinical encoding Release 2 CDA

  29. National & International PICNIC (European Union) SCIPHOX (Germany) HYGEIAnet/WebOnColl (Greece) NHS South Staffordshire (United Kingdom) Satakunta Macro Pilot (Finland) e-Claims Supporting Document Architecture (Canada) Local & Regional Mayo Clinic (USA) Buenos Aires project (Argentina) Dalhousie U, QEII Health Sci Ctr (Canada) CDA Implementations

  30. Joint project of Templates SIG, Structured Documents TC, Conformance SIG Open template registry/repository will contain normative and non-normative templates Tools for generating and validating templates will be developed This will take a while HL7 Templates

  31. WG20 / IISIG  Other HL7 groups Technical Committees Orders & Observations Vocabulary Structured Documents Laboratory Automation and Point of Care Testing Patient Care Control/Query Special Interest Groups Conformance Electronic Health Records (EHR) Security & Accountability Templates A Number of Connections

  32. WG14  SASIG  NEMA SPC  IHE IHE  Conformance SIG DICOM  ISO @ HL7 venues WG10  TC215/WG2 WADO  TC215/WG2 Also WADO  Structured Documents TC More Connections

  33. No big turf issues DICOM doesn’t want to define enterprise communications HL7 has no ambition or bandwidth to model specialty domain detail Each can learn from the other DICOM experience with persistent objects HL7 experience with modeling tools HL7 meetings are a good gathering place A Rewarding Partnership

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