DICOM Strategy

Cor Loefco-chair DICOM WG10:Strategic Advisory CommitteePhilips Medical Systems

IHE @ RSNA 2002

ContentsScope of DICOMCharter WG10: Strategic Advisory Cmt Trends in Imaging-IT Strategy Planning processCollaboration with other SDOs

IHE @ RSNA 2002

Scope of DICOMMission of DICOMCreate and maintain international standards for communication of bio-medical diagnostic and therapeutic informationGoals of DICOMAchieve interoperability and improve workflow efficiency between imaging systems and other information systems

IHE @ RSNA 2002

Charter of WG10To develop and maintain the long-term strategic plan of the DICOM Standards Committee. URL: http://medical.nema.org/dicom/geninfo/dicom_strategyTo review standards and technology trends in healthcare, biomedical imaging, commerce, telecommunications, and informatics; To consider issues and opportunities related to the strategic evolution of DICOM; To provide liaison to other standards developing organizations: ISO, HL7, JIRA, CEN

IHE @ RSNA 2002

OverviewScope of DICOMCharter WG10: Strategic Advisory Cmt Trends in Imaging-IT Strategy Planning processCollaboration with other SDOs

IHE @ RSNA 2002

Quality of care improved by information and IT:

All relevant information the care giver and patient need, anywhere and anytime, for the best clinical decisions through one common and simple user interface, adapted for the task.

IHE @ RSNA 2002

IHE @ RSNA 2002

Trends in Imaging-IT:Paradigm shiftActive workflow

IHE @ RSNA 2002

Vertical IntegrationThe Healthcare Enterprise

IHE @ RSNA 2002

Active Workflow

IHE @ RSNA 2002

Workflow in RadiologyDigitalRadiology

IHE @ RSNA 2002

Active WorkflowPersonalizedWork listFor each user

IHE @ RSNA 2002

Users default display protocol

IHE @ RSNA 2002

Paradigm shift in PACS:Clinical Applications to PACSYesterday

IHE @ RSNA 2002

Multi-slice CT: 1000+ images

IHE @ RSNA 2002

Post-Processing everywhereViewing & Advanced Image Processing:clinical SW packagesmove towards modalities, PACS and web3DSpineEndo3DCardiac MR

IHE @ RSNA 2002

Analysis tools to enhance clinical decisions:Echo measurements & calculationsLeft Ventricular AnalysisQuantitative Coronary AnalysisVascular X-Ray AnalysisVascular X-Ray Post-Processing

IHE @ RSNA 2002

Radiology PACSCardiologyPACSUltrasoundPACSVisible LightPACSOne Image Management InfrastructureRadiologyworkflowCardiologyworkflowUltrasoundworkflowPathologyworkflowHospital Information System, Master Person IndexHorizontal Integration

IHE @ RSNA 2002

Horizontal IntegrationImage (information) management system supports archiving/retrieving of all types of clinical objects (incl. visible light) and Structured Reports

IHE @ RSNA 2002

DICOM SR Creation - Example -RadiologyImage datafrom PACSCoding Schemes behind pop-up menus(Pointer)select

IHE @ RSNA 2002

Web based PACS

IHE @ RSNA 2002

Web and SecurityAt ModalityWeb ViewerPACS ViewingStationWebserverSecurity

IHE @ RSNA 2002

Electronic Health RecordImage Management system and Departmental Information Systems must be EHR-prepared (Query/Retrieve)EHR: emphasis today on visual integration on the desktop, will become the integrated, secure, patient centric, source of health informationNeed for coded vocabularies to represent medical knowledge and the patients health conditionWeb front-end: viewing not only of images but also waveforms, measurements, reports, lab results, etcneed the capability to access the original medical images support for (DICOM) Structured ReportingXML and XML Schema for the exchange of clinical documents

IHE @ RSNA 2002

EHR: Visual IntegationEfficiencyImproveClinicalDecisions

IHE @ RSNA 2002

OverviewScope of DICOMCharter WG10: Strategic Advisory Cmt Trends in Imaging-IT Strategy Planning processCollaboration with other SDOs

IHE @ RSNA 2002

Strategic planning processIn recent meetings WG10 has identified quite a number of strategic topics in the following domains:data acquisition, imaging technologypost-processing and presentationobject management and archivingdata and result distributiontreatment planningworkflow management

IHE @ RSNA 2002

The (multi-vendor) Integrated Imaging SolutionImageServerCDExchangeDepartmentInfo ServerDiagnostic WorkstationImage ArchiveConnection to other Networkand/or TeleCardiology

IHE @ RSNA 2002

Reduce ErrorsCodes and vocabulariesStructuredPresentationPersistentObject RefCodes and vocabularies

IHE @ RSNA 2002

Topics in Acquisition domain:Workflow outside the Radiology domain: RT, VL, Cardio. Requires specialized workflow. Refreshing the worklist, event based.Amount of data generated, kind of data generated.More, 3D, real-time, grayscale, color, time-sequence, textText really broadens the scope: evidence documents, key image note, codes, vocabularies, templates. Need for simple, small documents, e.g. just a few measurementsAmount of data will impact performanceNeed to manage separate objects that do belong together, SOP Class future. modeling instead of SOP ( HL7 way), separate info model from communication

IHE @ RSNA 2002

Topics in Acquisition/Post-processing domain:Integration, data from multiple modalities needed together, fused, merge recipe. Requires synchronization in time and/or space.US + CathLabPET + CTMR + NM Communication technologyMedia for exchange, profilesWireless (TCP/IP is on top of this, should be no issue)

IHE @ RSNA 2002

Topics in Archive domain:Delete service. All images come together in central archive with satellites. Co-operation in a loosely connected environment.Co-operation between multiple loosely connected workflow managers.

IHE @ RSNA 2002

Topics in Diagnostic Review domain:Presentation, have only grayscale presentation currently.color, 3D, waveform, Cine, MR-multiframehanging protocolsmulti-modality presentationSR presentationInteractive collaboration, tele-radiologyData mining, statistics, need for uniform definition.Should we organize a workshop on this topic?

IHE @ RSNA 2002

Topics in Reporting domain:Harmonization with CDA L3, XML encodingNext versions of TID 2000, templatesCodes, Vocabulary, Procedure Codes, Diagnostic Codes, HIPAA induced codes

IHE @ RSNA 2002

Topics in Result Distribution domain:DICOMs document paradigm: Persistent Object ReferenceExchange information outside the DICOM domainHIPAA, Privacy, Security, Authentication, VPNCD/DVD for exchange

IHE @ RSNA 2002

The distribution problemElectronic Patient RecordCardiologyPACSVL, US, NMPACSHISRISOtherClinicalSystemWeb ViewersWebserverURL/URI?

IHE @ RSNA 2002

Topics in Treatment/Treatment planning domain:CAD tools, HPGL standard, templates for implants3D, image guided surgery, contours, locate images in 3D spacemulti modality aspectImage fusion

IHE @ RSNA 2002

Strategic planning processSummary of the statements made:We started with the ultimate goal in mind: Quality of Patient Care, Continuity of Care, and the two contributing factors: fast and accurate diagnosis, and most effective treatment planThe key persons to support with information are the technologist, radiologist/cardiologist, and the referring clinician.Images, waveforms, measurement reports are generated and need an integrated presention to the key decision makers.We see this integration and presentation to the diagnostic decision maker as the top priority.

IHE @ RSNA 2002

Strategic planning processStatements (continued):We have the feeling that much is available in DICOM which is not deployed in practice to solve integration and presentation problems ==> Education and promotion taskThere will be gaps as well. ==> Identify the gaps in the Radiology, Cardiology, NM and US domainImaging (related) information from other domains (-ologies) needs to be integrated as well ==> Convince other -ologies to use the DICOM paradigm for their persistent objects.

IHE @ RSNA 2002

AcquisitionInterpretationRadiologyReportingAcquisitionInterpretationCardiologyReportingUltrasoundNMOther -ologiesArchiving plus Object managementStrategic prioritiesIntegration from acquisition via presentation to interpretation andreporting

IHE @ RSNA 2002

OverviewScope of DICOMCharter WG10: Strategic Advisory Cmt Trends in Imaging-IT Strategy Planning processCollaboration with other SDOs

IHE @ RSNA 2002

Standards in Imaging-IT1.Horizontal IntegrationDICOM2.Vertical IntegrationIHE, DICOM, HL73.Electronic Patient RecordISO/CEN,DICOM,HL7,XML4.Orders and Results IHE, DICOM, HL7 Management5.SecurityIHE,IETF,DICOM,HL7,ASTM6.Freedom of Application ISO/CEN, CCOW, IETF, WorkspotDICOM

When new technology is required, the strategy is to adopt proveninternational, industry or de facto standards.

IHE @ RSNA 2002

IHE - Integrating the Healthcare EnterpriseReducing the Barriers to Optimized Patient CareFostering communication between vendors and users of medical information technologyGaining knowledge of the data required for optimal patient care decisions, i.e. understanding each others problemsDriving the deployment and evolution of existing standardsEliminating the gaps and redundancies in data access.

IHE @ RSNA 2002

Liaison with TC 215Good Type A liaison since April 99.ProcedureTC 215 has agreed to rely on DICOM for Medical Imaging StandardizationDICOM offers expertise in medical imaging, with world-wide users and vendors representation.Need to ensure coherence with other ISO standards group on imaging related issues (e.g. ISO JTC1 SC9 on JPEG 2000)New workitem: Web Access to DICOMs Persistent Objects, co-operation of ISO TC 215/WG2 and DICOMin DICOM a WG6 ad-hoc group is established to work on the supplement, together with a group of ISO nominated experts

IHE @ RSNA 2002

Collaboration with HL7WG20: Integration of Imaging and Information Systems, common DICOM-HL7 working group.Works on the harmonization of the information models, HL7 RIM and DICOM Real-World model.Works on the harmonization of DICOM SR and the HL7 CDA (Clinical Document Architecture) level 1,2,3An informative annex to the DICOM standard will be created with the mapping of DICOM header data element to CDA level 1.CDA level 2 and 3 are progressing.

IHE @ RSNA 2002

The DICOM Standards Committee exists to create and maintain international standards for communication of bio-medical diagnostic and therapeutic information in disciplines that use digital images and associated data. The goals of DICOM are to achieve compatibility and to improve workflow efficiency between imaging systems and other information systems in healthcare environments worldwide.The DICOM Standards Committee exists to create and maintain international standards for communication of bio-medical diagnostic and therapeutic information in disciplines that use digital images and associated data. The goals of DICOM are to achieve compatibility and to improve workflow efficiency between imaging systems and other information systems in healthcare environments worldwide.