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12/6/2002 RSNA 2002
DICOM & IHE: What Are They, and
Why Do We Need Them?
DICOM & IHE: What Are They, and
Why Do We Need Them?
Sanjay JainDirector, Engineering, Cerner Corporation
Co-Chair, IHE Planning Committee
Sanjay JainDirector, Engineering, Cerner Corporation
Co-Chair, IHE Planning Committee
RSNA 2002RSNA 2002
12/6/2002 RSNA 2002
What Is DICOMWhat Is DICOM
• Digital Imaging and COmmunications in Medicine
• Began with ACR-NEMA initiative in late 1980s (also known as DICOM 2)
• Defines standard method to transfer images and related information between devices manufactured by various vendors
• DICOM 3.0 was introduced in 1992 with 9 parts, now there are 16 parts
12/6/2002 RSNA 2002
The DICOM StandardThe DICOM Standard
• Each part has a specific purpose– Part 2 : Conformance Statement– Part 4 : Service Class Specification– Part 6 : Data Dictionary– Part 10 : Media Storage and File Format
for data interchange– Part 14 : Gray Scale Standard Display
Function
12/6/2002 RSNA 2002
The DICOM Standard (contd.)The DICOM Standard (contd.)
• Defines Communication Protocol and content structure– Service Requested (e.g Modality Worklist)– Message structure and encoding (big
endian, little endian)– Tag Value pair for identifying information,
regardless of the transaction• Patient Name: (0010,0010) – Group 0010,
Element 0010• Patient ID: (0010,0020) – Group 0010, Element
0020
12/6/2002 RSNA 2002
Why DICOM?Why DICOM?
• Imagine if film from your camera could not be processed by neighborhood store but only a special agency– How timely would your pictures be available?– Will you keep on using the camera?– You want to process it easily and quickly.
• It was the same situation in Imaging • DICOM enabled exchange of digital imaging
and textual information using a Common Communication Protocol
• But left interpretation for implementers, so?
12/6/2002 RSNA 2002
Where do you use DICOM?Where do you use DICOM?
• Digital Scanners (CT, MR, CR, DR, etc.)
• Picture Archival and Communication System (PACS)
• Softcopy Display and Reading systems (Workstations)
• Film Printers
• Others…
How do you know if your scanner can save to the PACS?
12/6/2002 RSNA 2002
DICOM Conformance StatementDICOM Conformance Statement
• It is a detail document explaining implementation of DICOM standard in the Product– Defines the service classes implemented
and the role that system plays (SCP or SCU) for each class. E.g. ProVision implements Modality Worklist as an SCP
• Required to compare when reviewing systems for connectivity
• Need a technical staff person
12/6/2002 RSNA 2002
HL7/ HL7/ DICODICOMM
HLHL77
DICODICOMM
examination ordersfor J Doe
Orders Placed
HIS
imagesretrieved
acquisitioncompleted
acquisitioncompleted
J Doeimagesstored
J Doe
Enter patientas J Doe
EmergencyRegistration
Orders Filled
Image Managerand Archive
modality worklistfor J Doe
Modality
PACS
Reports storedfor Network
Access
RIS
Images and Examdata presented for
diagnosis
report
Patient Care WorkflowPatient Care Workflow
12/6/2002 RSNA 2002
HL7 and DICOMHL7 and DICOM
• They are both important for healthcare and digital imaging
• The information communicated using HL7 is typically Patient, Encounter, Procedure, Charges
• Same information is useful for Imaging process
But how does information flow between But how does information flow between systems implementing two standards?systems implementing two standards?
12/6/2002 RSNA 2002
Communication ChallengesCommunication Challenges
Systems need Information other systems have
But, systems communicate poorly or not at all
Result: - tedious, inefficient workflows - data that is inconsistent or unavailable
Responsibility for information flow between systems and between departments, is often unclear
12/6/2002 RSNA 2002
Integrating the Healthcare Enterprise
Integrating the Healthcare Enterprise
• It’s an initiative promoting and supporting the integration of systems in the healthcare enterprise
• Integration Goal: Improve the efficiency and effectiveness of clinical practice by:– Improved Information Flow– Advanced Multi-System Functions
12/6/2002 RSNA 2002
Who is IHE?Who is IHE?
• Participants:– Professional Societies (RSNA/HIMSS/…)– Vendors (over 30 companies)– Standards Group Committee Members
• RSNA and HIMSS sponsor IHE to provide a neutral forum for working on the Big Picture
12/6/2002 RSNA 2002
What Does IHE Do?What Does IHE Do?
• Users and vendors work together to identify and design solutions for integration problems
• Intensive process with annual cycles:– Identify key healthcare workflows and integration
problems– Research & select standards to specify a solution– Write, review and publish IHE Technical
Framework– Perform cross-testing at “Connectathon”– Demonstrations and Education at tradeshows
(RSNA/HIMSS)
12/6/2002 RSNA 2002
Key IHE ConceptsKey IHE Concepts
• Generalized Systems -> Actors
• Interactions between Actors -> Transactions
• Problem/Solution Scenarios-> Integration Profiles
12/6/2002 RSNA 2002
For each Integration Profile:
• the context is described (which real-world problem)
• the actors are defined (what systems are involved)
• the transactions are defined (what must they do)
Key IHE ConceptsKey IHE Concepts
12/6/2002 RSNA 2002
Access to Radiology InformationConsistent access to images and reports
Consistent Presentation of Images
Hardcopy and softcopy grayscale presentation state
Key ImageNotes
Flag significant images
Simple Image and Numeric Reports
Simple reports with image links and, optionally,
measurements
Basic SecurityAudit Trail Consolidation & Node Authentication
Presentation of Grouped Procedures
Subset a single acquisition
Post- Processing Workflow
Schedule, perform, & notify image processing
& CAD steps
Charge Posting
Collection of billable procedure details
Scheduled Workflow
Admit, order, schedule, acquire images, notify
of completed steps
Patient Information Reconciliation
Unknown patients and unscheduled orders
IHE Integration ProfilesIHE Integration Profiles
12/6/2002 RSNA 2002
Where is IHE going?Where is IHE going?
• Further Expansion in Radiology– Handling multiple Archives within the
institution
• Horizontal Expansion to – IT Infrastructure (Enabling EMR)– Desktop Integration– Cardiology
• Geographical Expansion to – Europe (Germany, France, UK, Italy)– Japan– …
12/6/2002 RSNA 2002
How do You benefit from IHE?How do You benefit from IHE?
• Clinical UsersClinical Users• Greater access to more consistent informationGreater access to more consistent information• Fewer errors, fewer tedious tasksFewer errors, fewer tedious tasks
• AdministratorsAdministrators• Increased throughputIncreased throughput• Better scheduling and trackingBetter scheduling and tracking
• BuyersBuyers• Specify/purchase integration capabilities Specify/purchase integration capabilities
easily easily • Freedom to acquire your selection of systemsFreedom to acquire your selection of systems
• IT ProfessionalsIT Professionals• Faster, more predictable integration projectsFaster, more predictable integration projects
12/6/2002 RSNA 2002
What IHE is NOTWhat IHE is NOT
• It is not a StandardIt is not a Standard• Has produced a FrameworkHas produced a Framework• Defines consistent and unambiguous use of Defines consistent and unambiguous use of
standardstandard
• It is not an OrganizationIt is not an Organization• Is an initiativeIs an initiative
• It is not a ProductIt is not a Product• Can’t buy IHE as a product Can’t buy IHE as a product • Ask for IHE integration profile implemented in Ask for IHE integration profile implemented in
Actors/Products you buyActors/Products you buy• It may be an upgrade, a feature or an option in It may be an upgrade, a feature or an option in
the productthe product
12/6/2002 RSNA 2002
DICOM & IHE: DICOM & IHE:
Can you have an Can you have an integrated Enterprise integrated Enterprise
Without Them?Without Them?
What Are They, and Why Do We Need Them?
What Are They, and Why Do We Need Them?
12/6/2002 RSNA 2002
ResourcesResources
• medical.nema.org• www.rsna.org/IHE• FAQs• Integration Profiles• Primer on IHE• Presentations• IHE Technical FrameworkThank
You