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Domain filler
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Document Sample
Imaging Integration SIG
Imaging Integration SIG ..........................................................................................................................................1
1. Introduction ......................................................................................................................................................1
1.1 Scope..............................................................................................................................................................1
1.2 Imaging orders ...............................................................................................................................................1
1.3 Order Status....................................................................................................................................................2
1.4 Results (Event) ...............................................................................................................................................2
1.5 Imaging Characteristics ..................................................................................................................................2
2. Application Roles (AR)........................................................................................................................................3
2.1 Application roles associated with images and reports ....................................................................................3
2.2 Application roles associated with images ......................................................................................................3
2.3 Application roles associated with reports .......................................................................................................4
3 Mapping of IHE Transactions and Story Boards ..................................................................................................7
3. 1 Placer Order Management.............................................................................................................................7
3.2 Filler Order Management ...............................................................................................................................8
3.3 Procedure Scheduled ....................................................................................................................................10
3.4 Procedure Update .........................................................................................................................................11
3.5 Image Manager ............................................................................................................................................11
3.6 Report Manager............................................................................................................................................11
1. Introduction
1.1 Scope
The scope of the imaging domain includes imaging intents, imaging orders and imaging
events. The notion of imaging covers signals acquired by imaging modalities, that is pixel
data, image header meta-data and associated reports.
1.2 Imaging orders
The request for imaging procedures contains the procedure code or name of the
procedure, the body region examined, indication and an optional procedure plan. As an
option, detailed requests for reporting may be included (e.g. the reporting template ID,
template code or name).
There are two types of imaging order messages: initial request and verified, active
order. The initial request is created by an external order placer and sent to the order filler,
while the verified order, which contains additional scheduling information, is transmitted
from the order filler to the image manager. The initial order request created by the order
placer will in most cases contain less detailed information about the imaging procedure being
ordered than the second type of imaging order message which is sent between imaging
information (sub-) systems (IIS).
Imaging procedures, as initially requested, are not necessarily verified by the imaging
order filler who is responsible for performing appropriate imaging procedures. The initial
request is therefore subject to „negotiation“ between order placer and order filler. The order
becomes active upon verification by the order filler. The imaging intent respectively plan of
the order placer is sent to the order filler as an initial order request. If the order filler agrees to
the order request, an accept message is sent back to the order placer and this new imaging
order gets activated (active imaging order). If the order filler disagrees with the new imaging
order, a reject message is sent back to the order placer. The order may in turn be modified or
revised.
Verification of the order is performed by the imaging order filler (i.e. the imaging
procedure is considered appropriate with regard to the clinical indication). The
appropriateness of the ordered imaging procedures is checked twice:
New imaging order by order filler (e.g. By using the Radiology Information System, RIS)
Scheduled imaging procedure at the point of care where the imaging procedure is
performed (e.g. Modality connected to the Picture Archiving and Communication System,
PACS)
These checks trigger the associated state transitions of the imaging order.
The scheduled imaging procedure message contains additional scheduling information
(e.g. service location) which is relevant for the order filler resp. the „department system
scheduler“ (see IHE application role).
1.3 Order Status
Ways to communicate the order status:
Unsolicited notification (e.g. order filler to order placer and vice versa, order filler to
image manager and vice versa)
Query order status (e.g. order filler queries image manager)
1.4 Results (Event)
An unsolicited event notification informs the issuer of the imaging order or other actors
interested in the results (e.g. Publish/subscribe mechanism) about relevant imaging events
(mood code = event).
These notifications are used to indicate events like:
Images available
Reports available
Pull and push mechanisms are used for results distribution.
Pull: Query Imaging Order Status and subsequently retrieve results
Push: Publish Imaging Results (e.g. Publish/subscribe mechanism)
1.5 Imaging Characteristics
One of the characteristics of the imaging domain is its inherent duality of imaging procedures
and associated reports.
Imaging Order:
Reports may be ordered explicitly along with the imaging procedure request or as a
stand-alone reporting order for previously acquired image data. Depending on the
standards of practice, the order filler may consider imaging procedure requests which
don´t contain explicit reporting requests implicit reporting orders and report on the
image data.
Results:
Imaging orders are considered complete, if either image acquisition or image
acquisition plus reporting has been completed
Service Relationships (RIM association class) are used to cover:
Relationships between Imaging Procedures
Relationships between Imaging Procedures and Reports
Results distribution: Image Data Volume
Rather than distribution of complete imaging studies, in most cases only images
showing the relevant findings will be distributed. Complete studies are sent upon
request.
2. Application Roles (AR)
2.1 Application roles associated with images and reports
Imaging Order Placer (sub-role of order placer)
A system that requests (places) one or more types of imaging orders. The types of
orders supported are determined by what sub-role(s) is/are supported.
Imaging Order Filler (sub-role of order filler)
A system that fullfills one or more types of imaging orders. The types of orders
supported are determined by what sub-role(s) are supported.
Corresponding IHE Application Role (AR): Department System Scheduler / Order
Filler
A departmental information system (e.g. Radiology Information System, RIS) that
provides functions related to the management of orders received from external
systems or through the department system’s user interface.
The imaging order filler tracks images and reports.
Information System (HIS/DIS/EPR)
Information system (IS) that receives imaging procedure results. The IS either gets a
notification about the order status (availability of images and / or reports) or receives
imaging order results. The information system is used as an application role, because
the target information system may be different from the order placer or there may be
additional information systems interested in getting the results (e.g. by using
Publish/Subscribe Mechanisms).
Sub-roles of Information System: Enterprise Image Repository, Enterprise Report
Repository Access, Enterprise Report Repository
2.2 Application roles associated with images
Acquisition Modality
IHE Definition: A system that acquires and creates medical images, e.g. a Computed
Tomography scanner or Nuclear Medicine camera. A modality may also create
Grayscale Softcopy Presentation States for the consistent viewing of images and create
Key Image Notes.
Key Image Note IHE Definition: The Key Image Note allows a user to mark one
or more images in a study as significant by attaching to them one or more notes
managed together with the study. Each note includes a title stating the purpose of
marking the images and a user comment. Physicians may attach Key Image Notes
to images for a variety of purposes: referring physician access, teaching files
selection, consultation with other departments, and image quality issues, etc. A
single Key Image Note may be reference several images within a study. Multiple
Key Image Notes may reference the same image.When a Key Image Note is
associated with an image, it may also reference a specific Presentation State for the
image thus ensuring that the significance of the Key Image Note includes the
image presentation state (window width/window level, flip, zoom, rotate, graphical
and textual annotations as defined in the Image Display ConsistencyConsistent
Presentation of Images Integration Profile).
Image Creator
IHE Definition: A system that creates additional images and/or presentation states
and/or Key Image Notes and transmits them to an Image Archive. It also makes
requests for storage commitment to the Image Manager for the data previously
transmitted and generates Performed Procedure Steps.
Image Manager / Image Order Tracker (sub-role of order tracker)
A system that tracks images associated with one or more types of imaging orders. The
types of orders supported are determined by what sub-role(s) are supported.
Corresponding IHE Application Role (AR): Image Manager
IHE Definition: A system that provides functions related to safe data storage and
image data handling. It supplies image availability information to the Department
System Scheduler. -> Comment: availability of reports associated with image
information has to be taken into account
The Image Manager is the Image Tracker of the Departmental Information System
(DIS) (e.g. Radiology Information System, RIS or Picture Archiving and
Communication System, PACS).
Image Archive
IHE Definition: A system that provides long term storage of images, presentation
states and Key Image Notes.
Performed Procedure Step Manager
IHE Definition: A system that re-distributes the Modality Performed Procedure Step
information from the Acquisition Modality or Image Creator to the Department
System Scheduler/Order Filler and/or Image Manager.
Comment: Status changes for reports are handled by the report manager (IHE
Application Role)
2.3 Application roles associated with reports
Report Creator
IHE Definition: A system that generates and transmits draft (and optionally, final)
reports, presenting them as DICOM Structured Reporting Objects.
Report Manager
IHE Definition: A system that provides functions related to report management. This
involves the ability to handle content and state changes to reports and to create new
DICOM Structured Reporting Objects (amendment: or HL7 CDA conformant reports)
based on these changes. In addition, the Report Manager generates and transmits
verified, unsolicited text results to the Enterprise Report Repository
Report Repository
IHE Definition: A system that provides long-term storage of reports and their retrieval
as DICOM Structured Reporting Objects.
Comment: The Report Manager transforms DICOM Structured Report Objects to HL7
compliant structured reports (e.g. HL V3 Clinical Document Architecture (CDA)
compliant objects)
Enterprise Report Repository
IHE Definition: A system that receives Structured Report Export Transactions from
the Report Manager and stores them.
Comment: This Report Repository is external to the Radiology Department or Imaging
Center. Structured Report Export Transactions, among others, use HL7 compliant
structured report objects (e.g. HL7 V3 CDA).
2.4 Relevant IHE Transactions
Image Manager
Storage Commitment
Images Availability Query
Procedure Update
Patient Update
Notification needed for Order Status Tracking
Modality Procedure Step in Progress
Modality Procedure Step Completed
Modality Images Stored (Images are sent directly to the Image Archive)
Creator Images Stored
Creator Procedure Step in Progress
Creator Procedure Step Completed
Report Manager
Report Submission
Report Issueing
Structured Report Export
Report
Order Placer Order Filler
Repository
Information System (EPR / HIS / DIS)
Enterprise Report Issuing
Image sub-role sub-role
Repository
Placer Order Report Report
Management
Imaging Order Imaging Order Manager Submission Report
Placer Filler Order Filler (Report Creator
Enterprise Management Tracker)
IS Manager Results Distribution Procedure Scheduled
/ Export Procedure Update
Image Availability Query
Enterprise Structured Report Export
Report
Repository
Image
Performed
Manager
Procedure Image Archive
(Image Order
Step Manager
Tracker)
Not defined by IHE
sub-role
Storage Commitment
Status Notification
Acquisition
Modality
Image Creator
Order Tracker
Fig. 1 Application Roles and Transactions
3 Mapping of IHE Transactions and Story Boards
Subset of relevant IHE transactions for HL7 V3 Imaging Orders & Observation Messages.
3. 1 Placer Order Management
IHE Definition: The Order Placer informs the Order Filler of the initiation or
cancellation of an order.
Extension: Imaging Order Placer sends an imaging order query message (i.e. a query
for the status of imaging procedures and / or reports) to the Imaging Order Filler.
Mapping to HL7 V3 messages
Story boards
Name: Imaging Order Placer sends new imaging order message to the
imaging order filler
ID: tbd.
Purpose: The imaging order placer sends a new imaging order (service mood
code = order) to the imaging order filler. The active imaging order is verified
by the imaging order filler who sends a response message back to the order
placer.
Diagram:
Storyboard Examples:
External Imaging Order Placer sends HL7 V3 Imaging Order Message.
This order in turn has to be negotiated between order placer and order
filler. If the order is accepted, the imaging order filler then forwards a
second order message including the approved imaging procedures and
additional scheduling information to the image manager resp. report
manager.
Imaging Order is directly entered into Imaging Information System
(e.g. Radiology Information System). The imaging order has been
verified, so there is no need for a subsequent negotiations between
order filler and order placer.
New imaging order accepted by order placer.
New imaging order rejected by order filler. The order filler responds by
sending an intent which indicates the required order modifications.
Name: Modification of existing imaging order (imaging order placer sends
unsolicited notification to imaging order filler)
ID: tbd.
Purpose: The imaging order placer notifies the imaging order filler of the
modification of an imaging order.
Diagram:
Storyboard Examples:
The intent resp. plan of the order filler for the modification of the non-
verified imaging request of the order placer doesn´t change the status of
the new order. The new order doesn´t get activated.
Stop Imaging Order: The active order is stopped before the start of the
ordered procedures. Example: A routine chest x-ray is scheduled for the
next 3 days. Patient is discharged on second day and exam for third day
is canceled.
Abort Imaging Order: Abort request message is sent while the imaging
procedures ordered are performed. Example: A nuclear medicine
procedure spanning two days is begun. Based on Day 1 results, the
remainder of the procedure is canceled.
Replace Imaging Order: Replace active order by modified order.
Example: A non-contrast CT examination is ordered. Prior to start of
the examination, a decision is made to change to a contrast-enhanced
examination.
Supercede Completed Imaging Order
Name: Query imaging order status
ID: tbd.
Purpose: The imaging order placer queries the order status from the imaging
order filler.
Diagram:
Storyboard Examples:
Queries for single imaging procedures and/or reports:
Simple Image Procedure Order Status Query: The requesting physician
queries the imaging order filler (RIS) for the status of a Thorax CT he
has ordered by providing the (Filler Order) Act ID (mood code =
order) and additional service information. He gets back the status of
the order instance, which is one of the enumerated values for Act
status_cd. (The imaging order placer may subsequently decide to
retrieve the results).
Simple Reporting Order Status Query Similiar to the above, but
applicable to reporting of existing images, such as overreads or
interpretation of outside exams.
Complex Imaging Order Status Query: Multiple imaging procedures
and / or associated report may exist of a filler order, but only a single
aggregate status is returned. For example, the order is designated as „in
progress“ as soon as the first imaging procedure step has begun, and is
„completed“ when all the final results (images and/or reports) are
available. In certain circumstances , it may be desirable to designate a
procedure as „in progress with partial results available“.
Queries for multiple imaging procedures and/or reports:
Query imaging procedures (period: start date/time – end date/time,
including imaging procedure status) -> images available?
Query imaging reports (period: start date/time – end date/time,
including imaging report status) -> reports available?
Complex query for imaging procedures and associated reports (period:
start date/time – end date/time, including imaging procedure and report
status)
3.2 Filler Order Management
IHE Definition: The Order Filler informs the Order Placer of the initiation,
cancellation, or change in the status of an order.
Accept and reject responses of Imaging Order Filler to request of Order Placer. These
generic accept and reject messages are used by the receiving facility.
Accept Imaging Order
Reject Imaging Order (The external imaging order is rejected by the order filler
-> reason code example: false indication, that is there is either no appropriate
imaging procedure at all or the order has to be changed. The intent of the
imaging order filler is sent to the imaging order placer.)
Mapping to HL7 V3 messages
Story boards
Deferred notification of order placer about modification of existing order
initiated by order filler
Non-deferred response messages are covered by Accept/Response
Messages mentioned above (refer to Filler Order Management section of
this document)
ID: tbd.
Purpose: The imaging order filler sends an unsolicited notification of
modifications of a previously placed order to the order placer. This notification
is deferred opposed to immediate accept / reject responses (the imaging order
has been initially accepted).
Diagram:
Storyboard Examples:
Modification due to deferred verification results (e.g. consultation,
second opinion, laboratory results) by imaging order filler
Modification due to condition at service location i.e. modality
Unsolicited notification of imaging order placer about imaging order statuses
ID: tbd.
Purpose: The imaging order filler sends an unsolicited notification of imaging
order statuses to the order placer.
Diagram:
Storyboard Examples:
Images Available
Reports available
Common order statuses for imaging orders
RIM order statuses: new, cancelled, active (in progress), suspended,
aborted, completed, superceded
Consideration of DICOM General Purpose Worklist (Suppl. 52)
statuses
Unsolicited notification of imaging procedures that were not ordered
ID: tbd.
Purpose: The imaging order filler sends an unsolicited notification of imaging
procedures which have been performed without being previously ordered by
the imaging order placer to the order placer or information system.
Diagram:
Storyboard Examples:
Emergency case
Walk-in patients
For notifications of existing orders refer to story board: Deferred
notification of imaging order placer about modification of existing order
initiated by order filler
Distribution / Export of Results (Results Distribution)
ID: tbd.
Purpose: The imaging order filler sends a results distribution message to the
imaging order placer. To that purpose, the imaging order filler integrates status
messages from the image manager and report manager (availability of images
and reports). The results distribution message contains references to the results
object instances (e.g. Uniform Resource Identifier, URI)
Diagram
Storyboard Example:
Results distribution message containing references to the original results
object instances ( e.g. URI) -> results distribution by reference
Results distribution message containing copies of the relevant images and /
or associated report(s) -> results distribution by value
Distribution of DICOM object instances (potential use MIME types: refer
to Draft DICOM Suppl. 54: DICOM MIME Type)
Distribution of rendered image objects (e.g. JPEG)
Distribution of structured reports (DICOM SR to HL7 CDA conversion is
performed by Report Manager)
For complex imaging orders results might get distributed by using multiple
messages in order to ease processing by avoiding overly complicated result
distribution messages.
3.3 Procedure Scheduled
IHE Definition: Schedule information is sent from the Department System Scheduler
(DSS)/Order Filler to the Image Manager.
This is an Inter-IIS (Imaging Information System) „Order Message“ (refer to the
contents of the IIS-Segment draft for scheduling information)
Mapping to HL7 V3 messages
Story boards
Name: Imaging Order Filler informs Image Manager of ordered imaging
procedures (active orders). Imaging scheduling data has been added.
ID: tbd.
Purpose: In addition to orders placed by the Imaging Order Placer this message
contains scheduling information (refer to IIS Segment). Scheduling data has
been added to the active order by the imaging order filler.
Diagram:
Storyboard Examples:
Simple Imaging Procedure Scheduled
Simple Reporting Procedure (without image acquisition) Scheduled
Complex Imaging Procedure Scheduled
Name: Imaging Order Filler informs Report Manager of completed
imaging procedure(s)
ID: tbd.
Purpose: To notify Report Manager of availability of images and that
reporting can begin.
Diagram:
Storyboard Example:
The completed imaging procedure(s) is/are ready for reporting. The
image manager notifies the report manager of these procedures (mood
code = event) which constitute observations without associated reports.
3.4 Procedure Update
IHE Definition: The Department System Scheduler/Order Filler sends the Image
Manager updated order or procedure information.
Storyboards:
Name: Modification of existing scheduled imaging and/or reporting
procedure (imaging order filler sends unsolicited notification to image
manager and/or report manager)
ID: tbd.
Purpose: The Imaging Order Filler notifies the image manager and/or report
manager of the modification of an scheduled imaging and/or reporting
procedure (refer to the contents of the IIS-segment draft for scheduling
information).
Diagram:
Storyboard Examples:
Stop Scheduled Imaging Order
Abort Scheduled Imaging Order
Replace Scheduled Imaging Order
