1September, 2005 What IHE Delivers

IHE Workshop: DisplayableIHE Workshop: DisplayableReports (DRPT)Reports (DRPT)

IHE Workshop 2006: Changing the Way IHE Workshop 2006: Changing the Way Healthcare ConnectsHealthcare Connects

Authors:Authors:

Anand KumarAnand Kumar, Siemens;, Siemens; Harry SolomonHarry Solomon, , GE Healthcare; GE Healthcare; Bryan Jennings, Bryan Jennings, Medical MicrographicsMedical Micrographics

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Purpose of Displayable Reports ProfilePurpose of Displayable Reports Profile

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

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The ProblemThe Problem

Most existing reporting applications operate Most existing reporting applications operate with paper paradigmwith paper paradigm PrintPrint Scribble (signature)Scribble (signature) FaxFax

““Advanced” apps have some electronic Advanced” apps have some electronic capabilitiescapabilities

Increasing demand for electronic report to Increasing demand for electronic report to central repositorycentral repository

Inconsistent requirements for how to do thisInconsistent requirements for how to do this

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Example Displayable ReportsExample Displayable Reports

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Real World Use CaseReal World Use Case

A Cardiologist reviews the observations and evidence A Cardiologist reviews the observations and evidence created during an exam. She prepares a report created during an exam. She prepares a report formatted as a PDF (on the Report Creator formatted as a PDF (on the Report Creator workstation), verifies it, and submits it to the workstation), verifies it, and submits it to the Cardiology department Information System (Report Cardiology department Information System (Report Manager). Manager).

The Report Manager stores it in the Cardiology The Report Manager stores it in the Cardiology department Report Repository; it also forwards it in an department Report Repository; it also forwards it in an HL7 message to the hospital’s Enterprise Repository HL7 message to the hospital’s Enterprise Repository for distribution of the Report outside the department. for distribution of the Report outside the department.

Within the department, access to the full procedure Within the department, access to the full procedure data set thus includes the PDF report as well as the data set thus includes the PDF report as well as the images and measurements.images and measurements.

Outside the department, the report as a PDF (through Outside the department, the report as a PDF (through the ITI RID Profile) is also available.the ITI RID Profile) is also available.

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Displayable Reports Profile Displayable Reports Profile Value PropositionValue Proposition

Many clinical reporting applications already Many clinical reporting applications already use PDFuse PDF

Supports graphical content (critical to Supports graphical content (critical to Cardiology reports)Cardiology reports) Including vector graphics for ECGsIncluding vector graphics for ECGs

Source system controls the “look” of the Source system controls the “look” of the reportreport Important for both clinical and business reasonsImportant for both clinical and business reasons In some jurisdictions, legal requirement for identical presentation In some jurisdictions, legal requirement for identical presentation

of a reportof a report

Image Manager/Image Archive (PACS) may be Image Manager/Image Archive (PACS) may be leveraged as departmental Report Repositoryleveraged as departmental Report Repository

Distributed enterprise report storage Distributed enterprise report storage architecture supportedarchitecture supported

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Real World Use Case 2Real World Use Case 2A patient has a follow-up appointment with his Cardiologist. A patient has a follow-up appointment with his Cardiologist. When the patient presents for his appointment, the Cardiologist When the patient presents for his appointment, the Cardiologist orders a standard ECG to be taken in the office at this time. The orders a standard ECG to be taken in the office at this time. The Cardiologist also retrieves a previous ECG from the Enterprise Cardiologist also retrieves a previous ECG from the Enterprise Repository (stored in a pdf format) for review. As a result of his Repository (stored in a pdf format) for review. As a result of his review of the results of the in-office and previous ECG’s, the review of the results of the in-office and previous ECG’s, the Cardiologist informs the attending nurse to setup a Nuclear Cardiologist informs the attending nurse to setup a Nuclear Spectroscopy Stress test at the nearby Nuclear Imaging Spectroscopy Stress test at the nearby Nuclear Imaging Diagnostic Center. Diagnostic Center.

At the hospital, the Cardiopulmonary department queries and At the hospital, the Cardiopulmonary department queries and retrieves ECG (in pdf format) information from the hospital’s retrieves ECG (in pdf format) information from the hospital’s Enterprise Repository. Both the in-office ECG and the previous Enterprise Repository. Both the in-office ECG and the previous ECGs are readily available for re-review by the Cardiologist or ECGs are readily available for re-review by the Cardiologist or consultation with other Cardiologists prior to conducting a consultation with other Cardiologists prior to conducting a diagnostic Cath Procedure Procedure.diagnostic Cath Procedure Procedure.

All of the above Reports are stored and available for query All of the above Reports are stored and available for query through the department’s local Report Repository, the through the department’s local Report Repository, the Cardiologist’s local Report Repository and the hospital’s Cardiologist’s local Report Repository and the hospital’s Enterprise Repository Enterprise Repository

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Summary of R.W. Use CasesSummary of R.W. Use Cases

Reports may originate from different sources (Report Reports may originate from different sources (Report Creators) Creators)

Report Creator may create a preliminary, final, or corrected Report Creator may create a preliminary, final, or corrected report. Report Manager manages the release process with report. Report Manager manages the release process with application-specific processing ruleapplication-specific processing rule

Department Report Manager provides local storage and Department Report Manager provides local storage and distribution of Reportsdistribution of Reports

Report Management System may use existing PACS Report Management System may use existing PACS capability for long term storage and distribution to Enterprise capability for long term storage and distribution to Enterprise RepositoryRepository

The Displayable Reports (DRPT) Profile is a bridge between The Displayable Reports (DRPT) Profile is a bridge between the Clinical Records stored in the Hospital department and the the Clinical Records stored in the Hospital department and the Longitudinal Record handled by the Cross Domain Sharing Longitudinal Record handled by the Cross Domain Sharing (XDS) Profile.(XDS) Profile.

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Displayable Reports ProfileDisplayable Reports ProfileActorsActors

Report CreatorReport Creator – A system that generates and – A system that generates and transmits clinical reports. transmits clinical reports.

Report ManagerReport Manager – A system that manages the status – A system that manages the status of reporting, and distributes reports to report repositories. of reporting, and distributes reports to report repositories.

Report RepositoryReport Repository – A departmental system that – A departmental system that receives reports and stores them for long-term access. receives reports and stores them for long-term access.

Enterprise Report RepositoryEnterprise Report Repository – A system that – A system that receives reports and/or references (pointers) to reports, receives reports and/or references (pointers) to reports, and stores them for access throughout the healthcare and stores them for access throughout the healthcare enterprise. enterprise.

Report ReaderReport Reader – A system that can query/retrieve and – A system that can query/retrieve and view reports encoded as DICOM objects.view reports encoded as DICOM objects.

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Displayable Reports ProfileDisplayable Reports ProfileTransaction DiagramTransaction Diagram

Enterprise Report Repos.

Retrieve Document

Report Reference Sub.

Report Creator

Encapsulated Submission

Report Reader

Report Manager

Report Repository

Query&Retrieve Encapsulated

Encapsulated Report Storage

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Report CreatorReport Creator Summary of RequirementsSummary of Requirements

Create PDF reportCreate PDF report

Send to Report ManagerSend to Report Manager

Does NOT persistently (long-term) store Does NOT persistently (long-term) store reportsreports Report Manager is responsible for content of Report Manager is responsible for content of

released report, and any local storage on Report released report, and any local storage on Report Creator may become inconsistent with official Creator may become inconsistent with official report (e.g., on Patient Update)report (e.g., on Patient Update)

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Report Manager Report Manager Summary of RequirementsSummary of Requirements

Receive PDF ReportReceive PDF Report

Manage release of reportManage release of report May release preliminary, or only final (per product May release preliminary, or only final (per product

feature or configured rules)feature or configured rules) Optionally manage electronic signaturesOptionally manage electronic signatures Add cover page in PDF with correct demographics Add cover page in PDF with correct demographics

and signature/statusand signature/status

Store report in department Report Store report in department Report RepositoryRepository

Forward report to Enterprise Report Forward report to Enterprise Report RepositoryRepository

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Enterprise Report RepositoryEnterprise Report Repository Summary of Requirements Summary of Requirements

Receive encapsulated PDF Receive encapsulated PDF

ororReceive PDF reference in HL7 messageReceive PDF reference in HL7 message

Deliver report to enterprise via unspecified Deliver report to enterprise via unspecified mechanismmechanism

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Displayable Reports ProfileDisplayable Reports Profile

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

If DICOM option not implemented, Report If DICOM option not implemented, Report Manager must be grouped with Report Manager must be grouped with Report RepositoryRepository Allowed to implement proprietary internal communicationAllowed to implement proprietary internal communication

DICOM Encapsulated PDF Query/Retrieve is DICOM Encapsulated PDF Query/Retrieve is an option for Report Repository an option for Report Repository If not implemented, workstations must use HTTP messaging If not implemented, workstations must use HTTP messaging

from Retrieve Information for Display Profile to access reportsfrom Retrieve Information for Display Profile to access reports

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The Report ReaderThe Report Reader

And what about DICOM Image workstations?And what about DICOM Image workstations?

Query/Retrieve DICOM Encapsulated PDF Query/Retrieve DICOM Encapsulated PDF Allows access to report in context of study images and evidence Allows access to report in context of study images and evidence Retrieve of complete DICOM study will also retrieve reportRetrieve of complete DICOM study will also retrieve report

Render PDF contentRender PDF content

Reasonable functionality to add to Image Reasonable functionality to add to Image Display (workstation)Display (workstation)

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DRPT and XDSDRPT and XDS

Displayable Reports Profile specifies Displayable Reports Profile specifies production of reports within an production of reports within an organizationorganization

Cross-enterprise Document Sharing (XDS) Cross-enterprise Document Sharing (XDS) Profile specifies distribution of reports Profile specifies distribution of reports outside the organizationoutside the organization

Typically, only a subset of internally Typically, only a subset of internally generated reports will be shared outsidegenerated reports will be shared outside

17September, 2005 What IHE Delivers

Questions?Questions?

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More information….More information….

IHE Web sites: IHE Web sites: www.ihe.netwww.ihe.net

Technical Frameworks, SupplementsTechnical Frameworks, Supplements• Cardiology Technical Framework Cardiology Technical Framework • IT Infrastructure Technical Framework IT Infrastructure Technical Framework • Displayable Reports SupplementDisplayable Reports Supplement

Non-Technical Brochures :Non-Technical Brochures :• Calls for ParticipationCalls for Participation• IHE Fact Sheet and FAQIHE Fact Sheet and FAQ• IHE Integration Profiles: Guidelines for BuyersIHE Integration Profiles: Guidelines for Buyers• IHE Connect-a-thon ResultsIHE Connect-a-thon Results• Vendor Products Integration StatementsVendor Products Integration Statements

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W W W . I H E . N E TW W W . I H E . N E T

Providers and VendorsProviders and Vendors

Working Together to DeliverWorking Together to Deliver

Interoperable Health Information SystemsInteroperable Health Information Systems

In the EnterpriseIn the Enterprise

and Across Care Settingsand Across Care Settings