Review and update of IHE The Future XDSI

Review and update of IHE The Future & XDS–I

Overview - IHE Updates n n IHE Organisational Changes The Infrastructure Domain Radiology Update XDS-I

IHE Political Update n IHE has moved on from Radiology n n n Cardiology Laboratory Patient Care Coordination (Vetinary) Moved on from US-centric n Established Regional and National Committees

Current IHE Domains n n n IT Infrastructure Radiology Cardiology Laboratory Nuclear Medicine

Profiles of Interest - ITI n Established: n n n n n Trial: n n n Patient Synchronized Applications (PSA) Patient Identifier Cross-referencing (PIX) Patient Demographics Query (PDQ) Personnel White Pages (PWP) Audit Trail and Node Authentication (ATNA) Enterprise User Authentication (EUA) Retrieve Information for Display (RID) Cross-Enterprise Document Sharing (XDS) Document Digital Signature (DSG) Notification of Document Availability (NAV) Development: n Cross-enterprise User Authentication (XUA)

New Profiles of Interest Radiology n Established: n n Trial: n n Reporting Workflow (RWF) Portable Data for Imaging (PDI) Post-Processing Workflow (PWF) Cross-enterprise Document Sharing for Imaging (XDS-I) Teaching File and Clinical Trial Export (TCE) Radiology Audit Trail Option Development: n n n Import Reconciliation Workflow (IRWF) Image Fusion (FUS) Mammography Image (MAMMO)

Current Intra-Trust/Cluster Image Sharing Problems n DICOM C-MOVE problems n n n Indexing n n n Error correction and cascading Multi-site studies n n Which trusts hold data for a patient? Updating n n Network Addressing Issues Unknown Recipients Where is “home” for the study ? Lack of agreement between Vendors on how to go forward How to bolt security onto DICOM

The IHE XDS Profile n n n “Generic” means of sharing clinical documents Part of ITI domain (not Radiology) Based on clinical and non-clinical standards: n n n Transmission: Indexing: Documents: http/https eb. XML CDA v 2 PDF etc.

XDS Concepts n Actors n n n Document Source Repository Registry Consumer Other concepts n “Submission Set”

XDS Overview Identity Source Document Registry Document Source Meta-Data Only User Document Repository Full Document

XDS-I n Like XDS but based on: n n Uses the same registry A submission set is a DICOM Key Object Note (manifest) object n n n DICOM (data format) WADO or native DICOM (retrieval mechanisms) May include representative sub-sets Use of WADO permits retrieval either as JPEGs for simpler browsers or full DICOM images Compatible with caching but still with integrity

XDS-I Overview Identity Source Image Registry Image Source Meta-Data Only User Image Repository Full Images Selected Manifest

Problems solved by XDS-I n n n n Use of WADO for retrieval solves C-MOVE problems One registry solves indexing problems There is an explicit mechanism to update/delete registrations (no equivalent in DICOM) “Submission Sets” are independent of Study. UID, so mixtures from different trusts are not a problem New but increasingly supported international standard (being implemented in Canada and many others) Uses Standard web security mechanisms Standardised access allows “web access” to be used for pre-fetching etc. , and integration with other clinical data

Conclusions n n n Virtually all the problems being worked on by Cf. H have already got agreed international IHE solutions which are supported by vendors XDS & XDS-I in particular provide a mechanism to provide wide-area, but fully controlled access to medical data, with proper specialisation for images The Connectathon next week should be interesting!