ihe radiology –2007what ihe delivers 1 christoph dickmann ihe technical committee march 2007 cross...
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1IHE Radiology –2007 What IHE Delivers
Christoph DickmannChristoph Dickmann
IHE Technical CommitteeIHE Technical Committee
March 2007March 2007
Cross Domain Review Cross Domain Review PCCPCC
3IHE Cross-Domain ReviewIHE Cross-Domain Review
Domains used in PCCDomains used in PCC
IT Infrastructure XDS, XDM, XDR, NAV, ATNA, CT XDS-SD
4IHE Cross-Domain ReviewIHE Cross-Domain Review
IHE PCC Integration Profile IHE PCC Integration Profile Cross-enterprise Sharing of Medical Summaries (XDS-MS)Cross-enterprise Sharing of Medical Summaries (XDS-MS)
Cross-enterprise Sharing of Medical Summaries
Defines a summary of patient data in narrative and/ or structured way that is used when transferring the patient from one care provider to another one for- general / specific audience - focused / broader range of patient problems.
5IHE Cross-Domain ReviewIHE Cross-Domain Review
XDS-MS FeaturesXDS-MS Features
An XDS content profile Uses & constraints the CDA R2 Care Record Summary (CRS)
implementation guide Render CDA R2 for viewing & printing consistently Options to ITI XD* actors:
• Source side– referral/ discharge summary content– support coded entries beyond XDS-MS defined codes
• Consumer side– view/ print document (incl. linked documents)– import document, sections or individual entries
Defines 61 specific IHE CDA modules/ templates Defines 11 specific IHE Act codes
Features similar to Radiology XDS metadata CDA content modules – similar to DICOM SR templates
• Narrative text• Coded text – mainly LOINC and HL7 codes
6IHE Cross-Domain ReviewIHE Cross-Domain Review
IHE PCC Integration Profile IHE PCC Integration Profile Basic Patient Privacy Consents (BPPC) - TIBasic Patient Privacy Consents (BPPC) - TI
Basic Patient Privacy Consents
Defines a mechanism to create and enforce patient consent policies for disclosing shared documents, including the necessary data to be used in documents that carry consent information
7IHE Cross-Domain ReviewIHE Cross-Domain Review
BPPC FeaturesBPPC Features
An XD* content profile that adds options Privacy Option for XDS Source, Consumer, Registry Privacy Option for XDR Source and Consumer Privacy Option for XDM Media Creator and Importer Uniquely identifiable privacy policy that can be referenced from shared documents Consents can be:
• Scanned paper document (“wet signature” XDS-SD)• CDA consent document that is digitally signed• Implied and not documented in the shared document• Explicit and documented/ referenced in the shared document
Specific CDA template (specific template ID) CDA confidentiality code references the privacy policy OID (configuration issue)
• Document Source sets the value appropriately for all documents• XDS Registry checks the validity of the code, and does code matching for queries• Doc. Consumer may include confidentiality code in queries, uses policy decision logic
Features similar to Radiology XDS metadata HL7 CDA and PDF documents
8IHE Cross-Domain ReviewIHE Cross-Domain Review
IHE PCC Integration Profile IHE PCC Integration Profile Emergency Department Referral (EDR) - TIEmergency Department Referral (EDR) - TI
Emergency Department Referral
Defines a referral document that provides summarizing information on a patient’s past medical problems, allergies, medications or assessment plan to the ED physician
9IHE Cross-Domain ReviewIHE Cross-Domain Review
EDR FeaturesEDR Features
An XD* content profile Defines 4 CDA section templates for CDA body Re-uses 3 section templates from XDS-MS
Features similar to Radiology Content in the referral similar to DICOM Patient
Medical Module
Note: I think the documentation is difficult to navigate and read (document > section > entry definitions are separate in TF-2)
10IHE Cross-Domain ReviewIHE Cross-Domain Review
IHE PCC Integration Profile IHE PCC Integration Profile Exchange of Personal Health Record Content (XPHR)Exchange of Personal Health Record Content (XPHR)
Exchange of Personal Health Record Content
Defines summary information extracted from a PHR system used by a patient for import into healthcare provider information systems, and visa versa.
PHR information typically used is address, telephone numbers, birth date, sex, marital status, emergency contacts, insurance information, a medical and family history, and current medications and allergies.
11IHE Cross-Domain ReviewIHE Cross-Domain Review
XPHR FeaturesXPHR Features
An XD* content profile Create / update PHR extracts
(incl. functional requirement to add/ replace/ remove sections/ entries) Import document/ section/ entry – equal to XDS-MS View individually or consistently a PHR document Use of DSG is recommended (option): Created PHR document should be signed,
consumers should be able to verify a signature Maps AHIM-PHR to ASTM CCR, HL7 CCR/CRS and HL7 PHR Extends HL7 CDA by
• Document section updates (replacementOf) • insurance identifiers, • patient identifiers of different providers
Features similar to Radiology None found (potentially some content)
Note: Options and “bindings” may be difficult to understand, e.g. why can’t I exchange PHR information by using basic XDS?
12IHE Cross-Domain ReviewIHE Cross-Domain Review
IHE PCC Integration Profile IHE PCC Integration Profile Pre-procedure History and Physical (PPHP) - TIPre-procedure History and Physical (PPHP) - TI
Pre-procedure History and Physical
Defines patient data necessary to evaluate/ ameliorate the risk for ambulatory procedures that require anesthesia. It is used for preparing the procedure and patient.
Such information can be: diagnoses, proposed procedure, laboratory and imaging studies, history & physical examinations.
13IHE Cross-Domain ReviewIHE Cross-Domain Review
PPHP FeaturesPPHP Features
An XD* content profile Defines a CDA template with ~ 50 sections (many
of those optional) No specific behavior defined;
Incorrect reference to “binding” to other (XD*) profiles
Features similar to Radiology None found (potentially some content)
14IHE Cross-Domain ReviewIHE Cross-Domain Review
IHE PCC ActorsIHE PCC Actors
Actors that are different
Content Creator – create and provide a • medical summary (XDS-MS)• consent document (BPPC)• ED referral (EDR)
Content Consumer – view, import or process a medical summary, similar as above for XDS-MS, BPPC, EDR
PHR Manager creates and provides a PHR extract; imports/ consumes PHR data/ updates PHR Reviewer consumes PHR extracts, and may be able to update an extract
Actors from non RAD-domains Required grouping of Content Creator with: XDS/ XDR Doc. Source or XDM Media Creator Required grouping of Content Consumer with: XDS/ XDR Doc. Consumer or XDR Media
Importer Optional grouping of Content Creator/ Consumer with: NAV Notif. Sender/ Receiver or DSG
Doc. Source/ Consumer
List of Actors extensively the same as Radiology none
15IHE Cross-Domain ReviewIHE Cross-Domain Review
IHE PCC TransactionsIHE PCC TransactionsNote: Options are documented in Profile descriptions
List of transactions that are different none
List of transactions that are extensively the same Re-use of XDS, XDM, XDR transactions
List of Transactions are extensively the same as Radiology none
16IHE Cross-Domain ReviewIHE Cross-Domain Review
Standards Used in PCCStandards Used in PCC
Standard Std. Version Profile(s) Used
HL7 CDA R 2.0 XDS-MS, BPPC, EDR, PPHP
XHTML Basic XDS-MS
DEEDS (CDC) 1.0 (1997) EDR
HL7 CCD/ CRS/ PHR
? XPHR
AHIMA-PHR ? XPHR
LOINC ? XPHR (any CDA)
Note: references to standards may be improved, e.g. PPHP 5.4.1.8.1
17IHE Cross-Domain ReviewIHE Cross-Domain Review
Summary of PCCSummary of PCC
Profile Issue Description How to HandleXDS-MS
Relation of RAD reports to medical summaries.Investigate if section contents are usable for IHE/ RAD reporting.
5 (clarify if this is consi-dered a gap by PCC)
BPPC Reference BPPC in XDS-I? Potentially 1
EDR Align patient EDR referral information to OMI when a “SWF 2” is created?
Potentially 2
XPHR Align CDA extensions for Insurance or Other Providers’ identifier for “SWF 2”?
Potentially 2
PPHP Procedure = invasive / surgical CP on missing actor specification ?
3
<code missing ?>
18IHE Cross-Domain ReviewIHE Cross-Domain Review
Key to Domain issuesKey to Domain issues
1. Issue should result in CP in Radiology
2. Consider addition in Radiology
3. Conflict between Radiology and other Domain
4. Radiology Profile should be handed-off to other Domain
5. Gap has been identified that may result in New Opportunity