HL 7 Health Level 7 DICOM Digital Imaging

HL 7 Health Level 7 DICOM Digital Imaging and Communication in Medicine Worzyk FH Anhalt Telemedizin WS 08/09 HL 7 - DICOM - 1

Communication in a hospital Administration Worzyk FH Anhalt Laboratory Radiologie surgery documentation Telemedizin WS 08/09 HL 7 - DICOM - 2

Communication in the past • Individual interface between ever two systems • High developing costs n * (n-1) interfaces for n systems • extensive documentation • high maintenance costs • high expenditure with exchange of equipment Worzyk FH Anhalt Telemedizin WS 08/09 HL 7 - DICOM - 3

HL 7 is an international community of healthcare subject matter experts and information scientists collaborating to create standards for the exchange, management and integration of electronic healthcare information. HL 7 promotes the use of such standards within and among healthcare organizations to increase the effectiveness and efficiency of healthcare delivery for the benefit of all. Worzyk FH Anhalt Telemedizin WS 08/09 HL 7 - DICOM - 4

Communication with HL 7 In 1987 the USA a working group was established with the goal: • Supply of formats and protocols for data exchange in the health service • Standardization of the contents • More efficient communication • Standardized language • Reduction of the implementation expenditure • International Standard Worzyk FH Anhalt http: //hl 7. org/ http: //www. hl 7. de/ Telemedizin WS 08/09 HL 7 - DICOM - 5

Messages • Aufnahme, Verlegung, Entlassung (admission, discharge, transfer = ADT) • • • Anfragen (queries) Untersuchungsergebnisse (result reports) Buchhaltung / Finanzen (finance) Patientenversorgung (patient care) Terminplanung (scheduling) Rezept (pharmacy prescription) Worzyk FH Anhalt http: //www. hl 7. de/links/demodb/hl 7 v 231. htm Telemedizin WS 08/09 HL 7 - DICOM - 6

Events The transmission of the messages is triggered by events Example: A 01 stationäre Aufnahme Admit A 02 Verlegung Transfer A 03 Entlassung Discharge A 08 Änderung Update Worzyk FH Anhalt http: //www. hl 7. de/links/demodb/hl 7 v 231 event. htm Telemedizin WS 08/09 HL 7 - DICOM - 7

Example Radiologie Administration A 01 ACK ACK Worzyk FH Anhalt Laboratory surgery documentation Telemedizin WS 08/09 HL 7 - DICOM - 8

Example Patient unknown Administration query message response message Laboratory Worzyk FH Anhalt Telemedizin WS 08/09 HL 7 - DICOM - 9

Composition of messages • Messages consists of segments and begin with a Message Segment Header MSH • Segments consists of an ordered sequence of fields Fields can be mandatory or optional Worzyk FH Anhalt Telemedizin WS 08/09 HL 7 - DICOM - 10

Datatypes of fields ST String XPN Person Name TX Text XAD Adresse FT Formatted Text XTN Telefon Number NM Numeric ID Coded Value HL 7 table DT Date IS Coded Value user defined TS Timestamp CN Composite PL Person Location Worzyk FH Anhalt Telemedizin WS 08/09 HL 7 - DICOM - 11

Example of Codetabelle Attributwert Description Bezeichnung F Female weiblich M Male männlich O Other andere U Unknown unbekannt Worzyk FH Anhalt Telemedizin WS 08/09 HL 7 - DICOM - 12

A 01 ADMIT A PATIENT Worzyk FH Anhalt MSH Message Header EVN Event Type PID Patient Identification [PD 1] Additional Demographics [ { NK 1 } ] Next of Kin /Associated Parties PV 1 Patient Visit [ PV 2 ] Patient Visit - Additional Info. [ { DB 1 } ] Disability Information [ { OBX } ] Observation/Result [ { AL 1 } ] Allergy Information [ { DG 1 } ] Diagnosis Information [ DRG ] Diagnosis Related Group [ { --- PROCEDURE begin PR 1 Procedures [{ROL}] Role } ] --- PROCEDURE end [ { GT 1 } ] Guaranto [ { --- INSURANCE begin IN 1 Insurance [ IN 2 ] Insurance Additional Info. [ {IN 3} ] Insurance Additional Info. - Cert. } ] --- INSURANCE end Telemedizin WS 08/09 HL 7 - DICOM - 13

Notation of Cardinality Worzyk FH Anhalt Telemedizin WS 08/09 HL 7 - DICOM - 14

Segments Used in DUMC ADT Messages AL 1 DG 1 EVN MRG MSH NK 1 OBX PID PV 1 PV 2 ZAP ZID ZV 1 Worzyk FH Anhalt Allergy Information Diagnosis Information Event Type Merge Information Message Header Next of Kin Observation Patient Identification Patient Visit - Additional Information DUMC Appointment Segment DUMC Patient Identification Extension DUMC Patient Visit Extension Telemedizin WS 08/09 HL 7 - DICOM - 15

Example ADT – message admission of patients A 01 - Admit a Patient MSH|^~&|DMCADT||RADIS 1||199506281130||ADT^A 01|DMCADT 950628113012000|P|2. 2|||NE EVN|A 01|199506281130|||MCKEL 003 PID|||H 89213||BOOP^BETTY^B||19091012|F|JOHN WRIGHT|W|3380 HIDDEN OAK AVE^^DURHAM^NC^27704||(919)5557906|||U|UNK|241639|00000 PV 1||I|MIN^2411^01|3|||051001^MASSEY^E^WAYNE|||MRH||||C|||| A||027||||||||||A 01||10|||199506281129 ZV 1|S|I|N DG 1||||CAUDA EQUINA SYN. ||W DG 1||||CAUDA EQUINA SYN. ||A Worzyk FH Anhalt http: //www. hl 7. de/links/demodb/hl 7 v 231 event. A 01. htm DUMC HL 7 ADT Specifications Telemedizin WS 08/09 HL 7 - DICOM - 16

HL 7 with XML • Simpler to read • Simpler to validate • Bute the messages are much more longer – Example : • ADT - A 01 message 500 characters • ADT - A 01 as XML 2127 characters Example Worzyk FH Anhalt Telemedizin WS 08/09 HL 7 - DICOM - 17

CDA Clinical Document Architecture Document Hierarchy Header Level 1 Unconstrained CDA Body General dianostic finding Header Body Level 2 Section Level templates Body X - rax finding ECG finding Level 3 Entry Level templates Header Header Body Body CT MRT X - rax Worzyk FH Anhalt Endoscopy finding gastro oesophago Telemedizin WS 08/09 HL 7 - DICOM - 18

DICOM Digital Imaging and Communication in Medicine • In the year 1983 the American college of Radiology (ACR) and the National Electrical Manufactures Association (NEMA) created a committee. The goal was to develop a standard for medical pictures. • In the year 1985 the first version of this standard was presented. The file format and electrical point to point a connection between two devices were defined. • In the year 1993, DICOM 3. 0 a further developed standard was presented, which made communication possible between different partners over a network. http: //www. iftm. de/dicom/einfuehrung. htm Worzyk FH Anhalt http: //medical. nema. org/ Telemedizin WS 08/09 HL 7 - DICOM - 19

Goal of DICOM Standard The goal of the DICOM Standard is to achieve compatibility and improve workflow efficiency between imaging systems and other information systems in healthcare environments worldwide Description of the semantics of instructions and the appropriate files. Description of the range of the implemented standards Support of the communication in the network Open to new applications Use of existing international standards if possible and preparation of own standards Worzyk FH Anhalt http: //medical. nema. org/ Telemedizin WS 08/09 HL 7 - DICOM - 20

Standards Information Object Definition Abstract definition of objects for the transmission of digital medical images and information according these images – Normalized classes contain only attributes, which belong directly to the object; e. g. : the attributes of an x-ray – Compound classes can contain also attributes, which belong indirectly to the object; e. g. the patient data and diagnoses to the x-ray Worzyk FH Anhalt Telemedizin WS 08/09 HL 7 - DICOM - 21

Standards Service Class Specification Spezification of services: A class of services joins one or more information objects with services that can be performed with these objects. Examples of services: Storing of data Searching Working lists Printing Worzyk FH Anhalt Telemedizin WS 08/09 HL 7 - DICOM - 22

Standards Data Dictionary • centralized registry which defines the collection of all DICOM Data • For each element, the data dictionary specifies: — its unique tag, which consists of a group and element number — its name — its value representation (character string, integer, etc) — its value multiplicity (how many values per attribute) Worzyk FH Anhalt Telemedizin WS 08/09 HL 7 - DICOM - 23

Standards Data Structure and Semantics • specifies how DICOM applications construct and encode the Data Set information – For example specification of image compression • addresses the encoding rules necessary to construct a Data Stream • defines the semantics of a number of generic functions Worzyk FH Anhalt Telemedizin WS 08/09 HL 7 - DICOM - 24

Standards Message Exchange specifies both the service and protocol used by an application in a medical imaging environment to exchange Messages Worzyk FH Anhalt Telemedizin WS 08/09 HL 7 - DICOM - 25

Standards Message Exchange This Standard defines: — the operations and notifications made available to Service Classes — rules to establish and terminate associations provided by the communications support and the impact on outstanding transactions — rules that govern the exchange of Command requests and responses — encoding rules necessary to construct Command Streams and Messages. Worzyk FH Anhalt Telemedizin WS 08/09 HL 7 - DICOM - 26

Standards Network Communication Support Media Storage and File Format Worzyk FH Anhalt Telemedizin WS 08/09 HL 7 - DICOM - 27

Standards Media Storage Application Profiles • specifies application specific subsets of the DICOM Standard to which an implementation may claim conformance. • Is required for the exchange of medical images and related data between different applications Worzyk FH Anhalt Telemedizin WS 08/09 HL 7 - DICOM - 28

Standards Storage Functions and Media Formats for Data Interchange facilitates the interchange of information between applications in medical environments by specifying: – A structure for describing the relationship between the media storage model and a specific physical media and media format. – Specific physical media characteristics and associated media formats. Worzyk FH Anhalt Telemedizin WS 08/09 HL 7 - DICOM - 29

Standards Conformance defines principles that implementations claiming conformance to the. Standard shall follow – specifies the general requirements which must be met by any implementation claiming conformance. – defines the structure of a Conformance Statement. Worzyk FH Anhalt Telemedizin WS 08/09 HL 7 - DICOM - 30

Standards Worzyk FH Anhalt Telemedizin WS 08/09 HL 7 - DICOM - 31

Examples • PACS Picture Archiving and Communication System http: //www. vepro. com/USA/solutions/PACS. asp RIS Radiologie Information System http: //www. klinikenheidenheim. de/klinik/Kliniken_und_zentrale_Einrichtungen/R oentgendiagnostik/index. php Integration http: //www. unimainz. de/FB/Medizin/Radiologie/agit/berichte/dicom 2004/01_Bild datenmanagement. pdf http: //www. hipax. de/start. htm Worzyk FH Anhalt Telemedizin WS 08/09 HL 7 - DICOM - 32