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Clinical Document Architecture
Open Standards-based EPR Incorporating Radiology
Michael LaRocca
Agenda
Why are XDS, XDR, and CDA a perfect match?How do XDS, XDR, and CDA come together to achieve an Electronic Patient Record?How do RIS concepts and metadata map to XDS, XDR, and CDA?
Roles of CDA, XDS, and XDR
Clinical Content Community Sharing Direct Exchange
CDA XDS XDR
Patient SummaryReferral SummaryDischarge SummaryLab ReportMore…
• Document Submission• Document Storage• Document Registration• Document Sharing
• Document Submission• Document Receipt
Goals of CDA
CDA: Goals
Give priority to delivery of patient care.
Allow cost-effective implementation across as wide a spectrum of systems as possible.
Support exchange of human-readable documents between users, including those with different levels of technical sophistication.
Promote longevity of all information encoded according to this architecture.
Enable a wide range of post-exchange processing applications.
Promote exchange that is independent of the underlying transfer or storage mechanism.
Prepare the design reasonably quickly.
Enable policy-makers to control their own information requirements without an extension to this specification.
Overlapping Goals of CDA, XDS, and XDR
CDA, XDS, and XDR: Overlapping Goals
Give priority to delivery of patient care.
Allow cost-effective implementation across as wide a spectrum of systems as possible.
Support exchange of human-readable documents between users, including those with different levels of technical sophistication.
Promote longevity of all information encoded according to this architecture.
Enable a wide range of post-exchange processing applications.
Promote exchange that is independent of the underlying transfer or storage mechanism.
Enable policy-makers to control their own information requirements without an extension to this specification.
Agenda
Why are XDS, XDR, and CDA a perfect match?How do XDS, XDR, and CDA come together to achieve an Electronic Patient Record?How do RIS concepts and metadata map to XDS, XDR, and CDA?
IHE Core Services: Patient Identification via PIX(v3)
PHR Image Viewer Clinician PortalEHRDocument Consumers
Registration System
Lab SystemRadiology System
EMRDocument
Sources
PIX(v3) / PDQ(v3) Manager
Local ID: ABC Local ID: DEF
Global ID: XYZ
Local ID: GHI Local ID: JKL
XDSb Document Registry
Global ID: XYZ
IHE Core Services: Document Submission via XDSb
PHR Image Viewer Clinician PortalEHRDocument Consumers
Registration System
Lab SystemRadiology System
EMRDocument
Sources
PIX(v3) / PDQ(v3) Manager
Local ID: ABC Local ID: DEF
Global ID: XYZ
Local ID: GHI Local ID: JKL
XDSb Document Registry
Global ID: XYZ
XDSb Document Repository
Repository ID: 123
Document ID: 1
Content
XDSb Document Repository
Repository ID: 456
Document ID: 2
Content
Document ID: 3
Content
Document 1 Document 2
Document 3
IHE Core Services: Document Consumption via XDSb
PHR Image Viewer Clinician PortalEHRDocument Consumers
Registration System
Lab SystemRadiology System
EMRDocument
Sources
PIX(v3) / PDQ(v3) Manager
Local ID: ABC Local ID: DEF
Global ID: XYZ
Local ID: GHI Local ID: JKL
XDSb Document Registry
Global ID: XYZ
XDSb Document Repository
Repository ID: 123
Document ID: 1
Content
XDSb Document Repository
Repository ID: 456
Document ID: 2
Content
Document ID: 3
Content
Document 1 Document 2
Document 3
IHE Core Services: Cross Community Access via XCA
PHR Image Viewer Clinician PortalEHRDocument Consumers
Registration System
Lab SystemRadiology System
EMRDocument
Sources
PIX(v3) / PDQ(v3) Manager
Local ID: ABC Local ID: DEF
Global ID: XYZ
Local ID: GHI Local ID: JKL
XDSb Document Registry
Global ID: XYZ
XDSb Document Repository
Repository ID: 123
Document ID: 1
Content
XDSb Document Repository
Repository ID: 456
Document ID: 2
Content
Document ID: 3
Content
Document 1 Document 2
Document 3
XCA Initiating Gateway
IHE Core Services: Document Exchange via XDR
Point-to-Point
Source Destination
Point-to-Point through intermediary components
Source DestinationSourceHISP
DestinationHISP
Agenda
Why are XDS, XDR, and CDA a perfect match?How do XDS, XDR, and CDA come together to achieve an Electronic Patient Record?How do RIS concepts and metadata map to XDS, XDR, and CDA?
Metadata Mapping: RIS to CDA to XDS and/or XDR
Category RIS CDA XDS / XDR
Patient Information Name name sourcePatientInfo
Date of Birth birthTime sourcePatientInfo
Sex administrativeGender
sourcePatientInfo
Address address sourcePatientInfo
Patient Number id sourcePatientId
National Number id patientId
Patient Class encompassingEncounter
Not Represented
Metadata Mapping: RIS to CDA to XDS and/or XDR
Category RIS CDA XDS / XDR
Creator Person Name author author
Grade / Function author authorRole
Contact Number author sourcePatientInfo
Responsible Team legalAuthenticator legalAuthenticator
Reporting Source author authorInstitution
Consumer Recipient Name intendedRecipient intendedRecipient
Grade / Function Not Represented Not Represented
Contact Number intendedRecipient Not Represented
Recipient Team intendedRecipient intendedRecipient
Recipient Target intendedRecipient intendedRecipient
Clinical Mapping: RIS to CDA
Category RIS CDA
Header Report Type ClinicalDocument/code
Accession Number ClinicalDocument/inFulfillmentOf/…order/id
DICOM Objects Section
Study act
Series act/entryRelationship/act
Service-Object Pair (SOP)Instance
act/entryRelationship/act/entryRelationship/observation
Findings Section Findings text (narrative)
Measurement entry/observation
Measurement (WADO) entry/observation/entryRelationship/observation
Conclusions Section Conclusions text (narrative)
DICOM SR “Basic Diagnostic Imaging Report” in CDA
http://www.hl7.org/documentcenter/public/wg/imagemgt/SrCdaMapping01.pdf
Clinical Document Architecture
Open Standards-based EPR Incorporating Radiology
Michael LaRocca
