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  1. DICOM HL 7 Health Level 7 Digital Imaging and Communication in Medicine

  2. Radiologie Administration surgery documentation Laboratory Communication in a hospital

  3. Communicationin the past • Individual interface between ever two systems • High developing costs n * (n-1) interfaces for n systems • extensive documentation • high maintenance costs • high expenditure with exchange of equipment

  4. HL7 HL7 is an international community of healthcare subject matter experts and information scientists collaborating to create standards for the exchange, management and integration of electronic healthcare information. HL7 promotes the use of such standards within and among healthcare organizations to increase the effectiveness and efficiency of healthcare delivery for the benefit of all.

  5. Communication with HL7 In 1987 the USA a working group was established with the goal: • Supply of formats and protocols for data exchange in the health service • Standardization of the contents • More efficient communication • Standardized language • Reduction of the implementation expenditure • International Standard

  6. Messages • Aufnahme, Verlegung, Entlassung (admission, discharge, transfer = ADT) • Anfragen (queries) • Untersuchungsergebnisse (result reports) • Buchhaltung / Finanzen (finance) • Patientenversorgung (patient care) • Terminplanung (scheduling) • Rezept (pharmacy prescription)

  7. Events The transmission of the messages is triggered by events Example: A01 stationäre Aufnahme Admit A02 Verlegung Transfer A03 Entlassung Discharge A08 Änderung Update

  8. Radiologie Administration surgery documentation Laboratory Example A01 A01 ACK A01 ACK ACK

  9. Administration Laboratory Example Patient unknown query message response message

  10. Composition of messages • Messages consists of segments and begin with a Message Segment Header MSH • Segments consists of an ordered sequence of fields Fields can be mandatory or optional

  11. Datatypes of fields

  12. Example of Codetabelle

  13. A01 ADMIT A PATIENT MSH Message Header EVN Event Type PID Patient Identification [PD1] Additional Demographics [ { NK1 } ] Next of Kin /Associated Parties PV1 Patient Visit [ PV2 ] Patient Visit - Additional Info. [ { DB1 } ] Disability Information [ { OBX } ] Observation/Result [ { AL1 } ] Allergy Information [ { DG1 } ] Diagnosis Information [ DRG ] Diagnosis Related Group [ { --- PROCEDURE begin PR1 Procedures [{ROL}] Role } ] --- PROCEDURE end [ { GT1 } ] Guaranto [ { --- INSURANCE begin IN1 Insurance [ IN2 ] Insurance Additional Info. [ {IN3} ] Insurance Additional Info. - Cert. } ] --- INSURANCE end

  14. Notation of Cardinality

  15. Segments Used in DUMC ADT Messages AL1 Allergy Information DG1 Diagnosis Information EVN Event Type MRG Merge Information MSH Message Header NK1 Next of Kin OBX Observation PID Patient Identification PV1 Patient Visit PV2 Patient Visit - Additional Information ZAP DUMC Appointment Segment ZID DUMC Patient Identification Extension ZV1 DUMC Patient Visit Extension

  16. Example ADT – messageadmission of patients A01 - Admit a Patient MSH|^~\&|DMCADT||RADIS1||199506281130||ADT^A01|DMCADT950628113012000|P|2.2|||NE EVN|A01|199506281130|||MCKEL003 PID|||H89213||BOOP^BETTY^B||19091012|F|JOHN WRIGHT|W|3380 HIDDEN OAK AVE^^DURHAM^NC^27704||(919)555-7906|||U|UNK|241639|000000000 PV1||I|MIN^2411^01|3|||051001^MASSEY^E^WAYNE|||MRH||||C||||A||027|||||||||||||||||||A01||10|||199506281129 ZV1|S|I|N DG1||||CAUDA EQUINA SYN.||W DG1||||CAUDA EQUINA SYN.||A DUMC HL7 ADT Specifications

  17. HL7 with XML • Simpler to read • Simpler to validate • Bute the messages are much more longer • Example : • ADT - A01 message 500 characters • ADT - A01 as XML 2127 characters Example

  18. Header Header Header Header Header Header Header Header Body Body Body Body Body Body Body Body CDAClinical Document Architecture Document Hierarchy Level 1 Unconstrained CDA General dianostic finding Header Level 2 Section Level templates Body ECG finding X - rax finding Endoscopy finding Level 3 Entry Level templates X - rax CT MRT gastro oesophago

  19. DICOMDigital Imaging and Communication in Medicine • In the year 1983 the American college of Radiology (ACR) and the National Electrical Manufactures Association (NEMA) created a committee. The goal was to develop a standard for medical pictures. • In the year 1985 the first version of this standard was presented. The file format and electrical point to point a connection between two devices were defined. • In the year 1993, DICOM 3.0 a further developed standard was presented, which made communication possible between different partners over a network.

  20. Goal ofDICOM Standard The goal of the DICOM Standard is to achieve compatibility and improve workflow efficiency between imaging systems and other information systems in healthcare environments worldwide Description of the semantics of instructions and the appropriate files. Description of the range of the implemented standards Support of the communication in the network Open to new applications Use of existing international standards if possible and preparation of own standards

  21. StandardsInformation Object Definition Abstract definition of objects for the transmission of digital medical images and information according these images • Normalized classes contain only attributes, which belong directly to the object; e.g.: the attributes of an x-ray • Compound classes can contain also attributes, which belong indirectly to the object; e.g. the patient data and diagnoses to the x-ray

  22. StandardsService Class Specification Spezification of services: A class of services joins one or more information objects with services that can be performed with these objects. Examples of services: Storing of data Searching Working lists Printing

  23. StandardsData Dictionary • centralized registry which defines the collection of all DICOM Data • For each element, the data dictionary specifies: — its unique tag, which consists of a group and element number — its name — its value representation (character string, integer, etc) — its value multiplicity (how many values per attribute)

  24. StandardsData Structure and Semantics • specifies how DICOM applications construct and encode the Data Set information • For example specification of image compression • addresses the encoding rules necessary to construct a Data Stream • defines the semantics of a number of generic functions

  25. StandardsMessage Exchange specifies both the service and protocol used by an application in a medical imaging environment to exchange Messages

  26. StandardsMessage Exchange This Standard defines: — the operations and notifications made available to Service Classes — rules to establish and terminate associations provided by the communications support and the impact on outstanding transactions — rules that govern the exchange of Command requests and responses — encoding rules necessary to construct Command Streams and Messages.

  27. StandardsNetwork Communication SupportMedia Storage and File Format

  28. StandardsMedia Storage Application Profiles • specifies application specific subsets of the DICOM Standard to which an implementation may claim conformance. • Is required for the exchange of medical images and related data between different applications

  29. StandardsStorage Functions and Media Formats for Data Interchange facilitates the interchange of information between applications in medical environments by specifying: • A structure for describing the relationship between the media storage model and a specific physical media and media format. • Specific physical media characteristics and associated media formats.

  30. StandardsConformance defines principles that implementations claiming conformance to theStandard shall follow • specifies the general requirements which must be met by any implementation claiming conformance. • defines the structure of a Conformance Statement.

  31. Standards

  32. Examples • PACS Picture Archiving and Communication System RIS Radiologie Information System Integration