DICOM SR and CDA Rel 2

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DICOM SR and CDA Rel 2
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DICOM SR and CDA Rel 2
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DICOM SR and CDA Rel 2

• Summary Imaging Report (SIR)
• Patient Personal Record
• Back to Referring Physician

SIR
SIR is extract of Imaging Report
Specialized Diagnostics Intervention

• Mammo
• US
• Cardiac
• Ophthalmology

Imaging Reports
Images
Evidence Docs

• Specialist
• Evidence Structured Info
• Images Structured Info

Object referenceUse/create info content
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Strategic process

• We had a closer look at one of our main topics
• Structured reporting objects and templates,
  relationship with CDA Release 2
• Actions
• Update the Policy Paper on Structured Documents,
  also including IHE in discussion.Kevin, Niki,
  Charles, Cor. Review by Lloyd, John, Joel.
• Have telcon with WG20/WG10/WG6 about Radiology
  report workitem scope, purpose, DICOMs help in
  adoption process, collaboration with HL7.Also
  DICOM encapsulated CDA, sup 114

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Strategic Insights

• 1. Today in the clinical practice we hardly see
  any application of structured and coded reporting
  beyond the evidence documents. The expectation
  and vision is that the need for structured and
  coded reporting will emerge the coming years to
  facilitate decision support, full integration in
  the patients EHR, data mining and analysis to
  improve the theoretical foundation and practice
  of medicine.
• 2. The workload for creation of structured and
  coded reports is the most significant acceptance
  criteria for the reporting clinician. There
  should be a direct link between the guidelines
  and practice protocol and the template/document
  structure.
• 3. The expectation is that given the broad range
  of clinical domains, broad scope of the use cases
  that need to be supported, and IT infrastructures
  and applications that are in place today, there
  will be a coexistence of both DICOM SR and HL7
  CDA for encoding structured semantics.

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Strategic Insights

• 4. The reporting use cases identify the need to
  exactly capture the report layout. This is
  legally required in certain jurisdictions, and
  because of human perception and readability, and
  business presentation and reimbursement. PDF is
  well suited to support these requirements.
• 5. The assumption is that in some/many reporting
  use cases the reference to the evidence documents
  and images from the report is an important
  element in the report.
• 6. The assumption is that the report and the
  referenced evidence documents and images have to
  be incorporated in the patient's electronic
  health record.
• 7. Reaching agreement on clinical templates for
  specific applications is a significant challenge
  to the adoption of structured and coded
  reporting, both for the professional societies to
  generate and the IT infrastructure in the
  practice to be flexible enough to deal with these.

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Proposed Actions

• a. In the DICOM community we need to find and
  document at least one typical clinical use case
  where we believe DICOM SR is ideally suited to
  encode the structured report, and efficiently
  supports the whole scope of the use case
  including the verification, distribution and
  medical research. The DICOM standard has all the
  elements in place to support such an "all DICOM"
  structured reporting use case. 1. Breast Imaging
  Report, 2. Echo
• b. DICOM should communicate to the IHE community
  its acceptance of the coexistence of DICOM and
  HL7 constructs for the purpose of structured and
  coded reports.

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Proposed Actions

• c. WG20 is on the right track with the ongoing
  effort to harmonize the structured report content
  between DICOM SR and HL7 CDA, because in practice
  it may well be that it is more the hospital's IT
  and application infrastructure that is the
  decisive factor for the choice of structured
  report encoding, rather than the clinical use
  case. WG20 will be supported in their activity
  to define a Diagnostic Report template by the
  activity defined in action a.
• d. Because DICOM has a method for encapsulating
  PDF, IHE is encouraged to incorporate into the
  reporting workflow a mechanism by which DICOM SR
  is complemented by an equivalent encoding of the
  report in PDF.
• e. Advise to the DICOM Committee to set-up a
  liaison with Physicians EHR Coalition for the
  topic of clinical guidelines and the relationship
  to structured and coded reporting.