IHE Workshop: Displayable Reports DRPT

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IHE Workshop DisplayableReports (DRPT)

• IHE Workshop 2006 Changing the Way Healthcare
  Connects
• Authors
• Anand Kumar, Siemens Harry Solomon, GE
  Healthcare Bryan Jennings, Medical
  Micrographics

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Purpose of Displayable Reports Profile

• DRPT provides a methodology to create, finalize,
  archive, read, revise and distribute cardiology
  clinical reports from the department to the
  enterprise and beyond

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The Problem

• Most existing reporting applications operate with
  paper paradigm
• Print
• Scribble (signature)
• Fax
• Advanced apps have some electronic capabilities
• Increasing demand for electronic report to
  central repository
• Inconsistent requirements for how to do this

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Example Displayable Reports
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Real World Use Case

• A Cardiologist reviews the observations and
  evidence created during an exam. She prepares a
  report formatted as a PDF (on the Report Creator
  workstation), verifies it, and submits it to the
  Cardiology department Information System (Report
  Manager).
• The Report Manager stores it in the Cardiology
  department Report Repository it also forwards it
  in an HL7 message to the hospitals Enterprise
  Repository for distribution of the Report outside
  the department.
• Within the department, access to the full
  procedure data set thus includes the PDF report
  as well as the images and measurements.
• Outside the department, the report as a PDF
  (through the ITI RID Profile) is also available.

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Displayable Reports Profile Value Proposition

• Many clinical reporting applications already use
  PDF
• Supports graphical content (critical to
  Cardiology reports)
• Including vector graphics for ECGs
• Source system controls the look of the report
• Important for both clinical and business reasons
• In some jurisdictions, legal requirement for
  identical presentation of a report
• Image Manager/Image Archive (PACS) may be
  leveraged as departmental Report Repository
• Distributed enterprise report storage
  architecture supported

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Real World Use Case 2

• A patient has a follow-up appointment with his
  Cardiologist. When the patient presents for his
  appointment, the Cardiologist orders a standard
  ECG to be taken in the office at this time. The
  Cardiologist also retrieves a previous ECG from
  the Enterprise Repository (stored in a pdf
  format) for review. As a result of his review
  of the results of the in-office and previous
  ECGs, the Cardiologist informs the attending
  nurse to setup a Nuclear Spectroscopy Stress test
  at the nearby Nuclear Imaging Diagnostic Center.
• At the hospital, the Cardiopulmonary department
  queries and retrieves ECG (in pdf format)
  information from the hospitals Enterprise
  Repository. Both the in-office ECG and the
  previous ECGs are readily available for re-review
  by the Cardiologist or consultation with other
  Cardiologists prior to conducting a diagnostic
  Cath Procedure Procedure.
• All of the above Reports are stored and available
  for query through the departments local Report
  Repository, the Cardiologists local Report
  Repository and the hospitals Enterprise
  Repository

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Summary of R.W. Use Cases

• Reports may originate from different sources
  (Report Creators)
• Report Creator may create a preliminary, final,
  or corrected report. Report Manager manages the
  release process with application-specific
  processing rule
• Department Report Manager provides local storage
  and distribution of Reports
• Report Management System may use existing PACS
  capability for long term storage and distribution
  to Enterprise Repository
• The Displayable Reports (DRPT) Profile is a
  bridge between the Clinical Records stored in the
  Hospital department and the Longitudinal Record
  handled by the Cross Domain Sharing (XDS)
  Profile.

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Displayable Reports ProfileActors

• Report Creator A system that generates and
  transmits clinical reports.
• Report Manager A system that manages the status
  of reporting, and distributes reports to report
  repositories.
• Report Repository A departmental system that
  receives reports and stores them for long-term
  access.
• Enterprise Report Repository A system that
  receives reports and/or references (pointers) to
  reports, and stores them for access throughout
  the healthcare enterprise.
• Report Reader A system that can query/retrieve
  and view reports encoded as DICOM objects.

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Displayable Reports ProfileTransaction Diagram
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Report Creator Summary of
Requirements

• Create PDF report
• Send to Report Manager
• Does NOT persistently (long-term) store reports
• Report Manager is responsible for content of
  released report, and any local storage on Report
  Creator may become inconsistent with official
  report (e.g., on Patient Update)

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Report Manager Summary of
Requirements

• Receive PDF Report
• Manage release of report
• May release preliminary, or only final (per
  product feature or configured rules)
• Optionally manage electronic signatures
• Add cover page in PDF with correct demographics
  and signature/status
• Store report in department Report Repository
• Forward report to Enterprise Report Repository

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Enterprise Report Repository
Summary of Requirements

• Receive encapsulated PDF
• orReceive PDF reference in HL7 message
• Deliver report to enterprise via unspecified
  mechanism

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Displayable Reports Profile

• But how can a non-DICOM Report Manager play?

• If DICOM option not implemented, Report Manager
  must be grouped with Report Repository
• Allowed to implement proprietary internal
  communication
• DICOM Encapsulated PDF Query/Retrieve is an
  option for Report Repository
• If not implemented, workstations must use HTTP
  messaging from Retrieve Information for Display
  Profile to access reports

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The Report Reader

• And what about DICOM Image workstations?

• Query/Retrieve DICOM Encapsulated PDF
• Allows access to report in context of study
  images and evidence
• Retrieve of complete DICOM study will also
  retrieve report
• Render PDF content
• Reasonable functionality to add to Image Display
  (workstation)

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DRPT and XDS

• Displayable Reports Profile specifies production
  of reports within an organization
• Cross-enterprise Document Sharing (XDS) Profile
  specifies distribution of reports outside the
  organization
• Typically, only a subset of internally generated
  reports will be shared outside

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Questions?
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More information.

• IHE Web sites www.ihe.net
• Technical Frameworks, Supplements
• Cardiology Technical Framework
• IT Infrastructure Technical Framework
• Displayable Reports Supplement
• Non-Technical Brochures
• Calls for Participation
• IHE Fact Sheet and FAQ
• IHE Integration Profiles Guidelines for Buyers
• IHE Connect-a-thon Results
• Vendor Products Integration Statements

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Providers and Vendors Working Together to
Deliver Interoperable Health Information
Systems In the Enterprise and Across Care Settings