Integrating the Healthcare Enterprise - Radiation Oncology -

Transcription

1 Acknowledgements Integrating the Healthcare Enterprise - Radiation Oncology - Bruce Curran, M.S., M.E. Department of Radiation Oncology University of Michigan Ann Arbor, MI -RO ASTRO 2006 Mike Vannier Jay Cooper Keith LaPlain -RO Technical Committee iherotech@aapm.org 2007 Workshop Disclosures Outline Co-chair, -RO Technical Committee Funding from ASTRO for participation Vice-Chair, DICOM Working Group 7 Funding from AAPM for participation DICOM in Radiation Therapy Brief History Scope Why it doesn t work Brief History Structure and Current Activities -RO 1

2 AAPM / RTOG Originally Developed as AAPM Report #10 A Standard Format for Digital Exchange Modified by NCI Particle Intercomparison Contract Used by NCI High Energy Photon External Beam Contract Modified further by NCI Electron External Beam Contract Adopted and Significant Extended by RTOG QA Center DICOM 3 History Started as ACR-NEMA Committee formed in ACR-NEMA V ACR-NEMA V2.0 V1.0 & v2.0 image transfer based on point-to-point medium. Version 3, renamed DICOM 3. Used network for image transfer. DICOM 3 History DICOM 3 Structure The name was changed to separate the standard from the originating body Release of Parts 1 and 8 of DICOM RSNA demonstration, Part DICOM Parts 1-9 approved, RSNA demonstration of ALL parts Part 10: Media Storage and File Format Parts 11,12, and 13 plus Supplements Part 1 Overview Part 2 Conformance Part 4 Service Class Specifications Part 3 Information Object Definitions Part 6 Data Dictionary Part 5 Data Structure & Encoding Part 7 Message Exchange Part 8 Network Part 9 Point-to- Point Part 10 Storage Media & File Format Part 12 Physical Media Formats Part 11 Media Storage Appl. Profiles 2

3 MAGN ETOM LiteBox MAGN ETOM LiteBox LiteBox MAGN ETOM LiteBox Insurance e.g. EDIfact Pharmacy Laboratory Wards Healthcare Standards Hospital HIS HIS Treatment (RT) (RT) Pathology HL7 Cardiology Radiology DICOM ICU ICU General Practitioners e.g. EDIfact OR OR Surgery Teleradiology to clinics Print Management Media Exchange DICOM Application Domain Query/Retrieve Results Management Storage, Query/Retrieve, Study Component Query/Retrieve, Patient & Study Management Information Management System Radiation Therapy: Imaging + Departmental Data Flows Need for more that just s Field descriptions Prescription / Fractionation Information objects evolve At simulation, only basic setup information After planning, fields, doses, Verification data CT, Setup Simulator MR R&V / DB All SS, Plan, SS, Plan, Dose, SS, Plan Portal Imaging CT Sim RTP Linac Plan 3

4 DICOM RT Proposed at RSNA, 1994 Working Group started in 1995 as NEMA RT Section TG First objects approved in 1998 Added several objects for Radiation Therapy RT Dose RT Structure Set RT RT Plan RT Treatment Record(s) Since DICOM 3.1, just another part of DICOM DICOM Testing DICOM Part 2 specifies the structure of a conformance statement DICOM does not specify a test suite or a compliance verification mechanism All DICOM implementations must be supported by a properly constructed conformance statement DICOM Conformance Statement Hmmmmmm Implementation Model which describes the Application Entities in the implementation Detailed specification of each Application Entity SOP Classes supported policies for initiation and acceptance of associations Presentation Contexts SOP options Supported communications protocols Specializations Configuration DICOM The New Yorker, 7/2007 4

5 DICOM Conformance Statement Allow a user to determine which optional components of the DICOM Standard are supported by a particular implementation, and what extensions or specializations an implementation adds. By comparing the Conformance Statements from two implementations, a knowledgeable user should be able to determine whether or not interoperability is possible. The Problems DICOM-RT Objects Evolve Numerous Optional Fields Different Interpretations Stale Data Security HIPPA has heightened awareness of the need to protect data Network Protection / Isolation DICOM No formal testing structure Left to the user to examine manufacturer Conformance Statements to verify compatibility Knowledge necessary to truly verify compatibility is arcane, not easy to acquire or keep current Much more difficult for DICOM RT Extensions compared to images What is? Standards-based, Global Initiative generating Real-world Implementations in patient care Defining, testing, and implementing standards-based interoperability for EHR s 5

6 Why? brings reality to workflow 1970 s Mainframe Era--$100,000 per interface 1990 s HL7 2.x--$10,000 per interface 2000 s Implementation Profiles Cheaper than a new phone line! How? Eliminates Options found in Published Standards Who is? is a joint initiative among: American College of Cardiology (ACC) Radiological Society of North America (RSNA) Healthcare Information Management Systems Society (HIMSS) GMSIH, HPRIM, JAHIS (laboratory) American Society of Ophthalmology American College of Physicians (ACP) American College of Clinical Engineering (ACCE) And many more. Began in 1997 in Radiology (RSNA) and IT (HIMSS) International effort: - Europe and -Asia Additional sponsors for Cardiology including ASE, ESC, ASNC, SCA&I, HRS and more Sponsor Co-Chairs North America Europe Asia/Oceania Regional & National Deployment Organizational Structure Multi-Domain & Multi-National (International) Strategic Development Committee Delegates supervises Domain-related Planning and Technical Committees Global Development: Radiology, IT Infrastructure, Cardiology, Lab, etc. contribute Participants reports Global Interoperability 6

7 2006 Nine Active Domains Over 100 vendors involved world-wide, wide, 5 Technical Frameworks 37 Integration Profiles, Testing at Connectathons Demonstrations at major conferences world-wide wide 15 Active national chapters on 4 continents Radiology 14 Integration Profiles Laboratory 5 Integration Profiles Future Domains Electronic Health Record Pathology IT Infrastructure 13 Integration Profiles Eye Care Oncology Cardiology 4 Integration Profiles Patient Care Coordination 1 Integration Profile Patient Care Devices Standards-Based Integration Solutions Professional Societies Sponsorship Healthcare Providers & Software Developers Healthcare IT Standards HL7, DICOM, etc. Process General IT Standards Internet, ISO, etc. Interoperable Healthcare IT Solution Specifications Interoperable Healthcare IT Integration Solution Profile Specifications Interoperable Healthcare IT Integration Solution Profi le Specifications Interoperable Healthcare IT Integration Solution Profile Specifications Integration Profile P at i e n t I n f o r m at i o n R ec o n ci l i a ti o n Integration Profiles Scheduled Workflow Presentation of Grouped Procedures Consistent Presentation of s Evidence Documents Access to Radiology Information Basic Security Post- Processing Workflow - Reporting Workflow Key Notes Charge Posting Simple and Numeric Reports Standards Proven Standards Adoption Process Technical Framework Integration Integration Profiles B Profile A Connect-a-thon Results Connect-a-thon thon Product Integration Statement Product With Demonstration Easy to Integrate Products User Site RFP Integration Profiles at the heart of : Detailed selection of standards and options each solving a specific integration problem A growing set of effective provider/software-developer agreed solutions Vendors can implement with ROI 7

8 ADT Patient Update/ Pt. Registration [RAD-1] Pat ient Update/ Merge [RAD-12] Patient Update [RAD-12] Merge [RAD-12] Pt. Registration [RAD-1] Patient Update [RAD-12] Placer Order Management [RAD-2] Filler Order Management [RAD-3] DSS/ Order Filler Order Placer Modality PS in Progress [CARD-1] Procedure Scheduled [RAD-4] Modality PS Completed [RAD-7] Patient Update [RAD-12] Procedure Updated [RAD-13] Instance AvailabilityNotification [RAD-49] Evidence Display Modality PS in Progress [CARD-1] Creator Modality PS Completed [RAD-7] Query s [RAD-14] Storage Modality /Evidence Retrieve s/evidence [CARD-4] Performed Commitment Stored [CARD-2] Procedure [CARD-3] Step Manager Manager Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7] Modality PS in Progress [CARD-1] Modality PS Completed [RAD-7] Query ModalityWorklist [RAD-5] Storage Commitment [CARD-3] ADT Order Department System Placer Scheduler/ Manager/ Order Fi ller PPS Manager Regist er J.Doe Patient Registration [RAD-1] Placer Order Management One or the New [RAD-2] other methods of creating an order is used Filler Order Management - Schedule New [RAD-3] Procedure Procedure Scheduled [RAD-4] Patient Reconcili ation J.Doe -> J.Smith Acquisition Modality Query Modality Worklist [RAD-5] Modalit y Procedure Modality Procedure Fill er Order Step In Progress Step In Progress Mgmt - Status [CARD-1] [CARD-1] Update [RAD-3] Modality Procedure Modalit y Procedure Fill er Order Step Completed Step Compl eted Mgmt - Status [RAD-7] [RAD-7] Update [RAD-3] Modality /Evidence Stored [CARD-2] Acquisition Modality Perform Acquisition Technical Frameworks Connectathon Detailed standards implementation guides Open invitation to the Software Developer Community Advance testing tools (MESA) applied Compliance Testing organized and supervised by the sponsors of Thousands of cross-system tests performed Product Integration Statements validated Connectathon, January participants, 120+ systems 60+ systems developers Four Domains: Cardiology, IT Infrastructure, Patient Care Coordination, Radiology monitored test cases Request for Proposals (RFPs) Much easier to specify and agree to an Integration Profile than detailed technical specs: Device must support Scheduled Workflow Integration Profile, and vendor must supply an Integration Statement. Software Developer response: 8

9 Results Over 3000 attendees visited the HIMSS RHIO Showcase 37 vendors demonstrated 48 systems 700 attendees created and tracked their own health record 63 educational sessions were presented 5 International delegations 3 VIP tours 16 clinical scenarios were demonstrated -RO -RO DICOM WG-7 (April, 2004) Introduction to Discussion on how Radiation Oncology could participate NEMA Radiation Therapy Section At AAPM 2004, discussed need to improve interoperability in RT ASTRO Board of Directors Proposal, June 2004 Kick-off, ASTRO Annual Meeting, 2004 First Meeting of -RO PC & RSNA, 2004 Joint Effort led by ASTRO with AAPM, NEMA, and others -RO Technical Committee First Meeting, January, 2005 w/ DICOM WG-7 INTEGRATING THE HEALTHCARE ENTERPRISE () RADIATION ONCOLOGY (RO) Participants in -RO Advanced Technology Consortium (ATC) American Association of Physicists in Medicine (AAPM) American College of Radiology (ACR) American Society for Therapeutic Radiology and Oncology (ASTRO) Association of Radiation Oncologists of India (AROI) Canadian Association of Radiation Oncologists (CARO) Chinese Society of Radiation Oncologists (CSRO) CMS Egyptian Cancer Society Radiation Oncology Elekta European Society for Therapeutic Radiology and Oncology (ESTRO) International Atomic Energy Agency (IAEA) Impac Japanese Society for Therapeutic Radiology and Oncology (JASTRO) Miranda Solutions National Cancer Institute (NCI) National Electrical Manufacturers Association (NEMA) Nucletron Philips Tomotherapy Radiological Society of North America (RSNA) Siemens Varian 9

10 -RO INTEGRATING THE HEALTHCARE ENTERPRISE () RADIATION ONCOLOGY (RO) Participants in -RO Advanced Technology Consortium (ATC) American Association of Physicists in Medicine (AAPM) American College of Radiology (ACR) American Society for Therapeutic Radiology and Oncology (ASTRO) Association of Radiation Oncologists of India (AROI) Canadian Association of Radiation Oncologists (CARO) Chinese Society of Radiation Oncologists (CSRO) CMS Egyptian Cancer Society Radiation Oncology Elekta European Society for Therapeutic Radiology and Oncology (ESTRO) International Atomic Energy Agency (IAEA) Impac Japanese Society for Therapeutic Radiology and Oncology (JASTRO) Miranda Solutions National Cancer Institute (NCI) National Electrical Manufacturers Association (NEMA) Nucletron Philips Tomotherapy Radiological Society of North America (RSNA) Siemens Varian Exactly How Does -RO Function? Planning Committee Identifies information systems or components of information systems that produce, manage, or act on information associated with clinical and operational activities that require integration. Technical Committee Identifies and implements standards for interactions between actors that communicate the required information through standards-based messages. The PC and TC work together to Prioritize Efforts, Propose Solutions, and Eventually Demonstrate Connectivity - what did he just say? Imaging Study -RO Basic Interoperability Integration Profile Contouring System Simulation System -RO Actors Proposals circulating between Planning Committee and Technical Committee Many applications combine actors Planning Application Treatment Verification Rad Onc IMS Treatment Delivery Planning Workstation RT DICOM RT Plan G RT SSet RT Dose RT SSet RT Plan RT Dose Reference s Patient Registrar Multi-Media Registration Contouring Reference Point Generation Prescription Entry Beam Placer / Shaper Dose Calculator Plan Evaluator Fractionator Reference Creator 10

11 -RO CT Simulation Application -RO Treatment Planning Application Contouring & Beam Editor Application Planning Application RT RT SSet DICOM RT Plan G Multi-Media Registration Contouring Reference Point Generator Beam Shaper / Placer Prescription Entry Reference Creator Reference s RT DICOM RT Plan G RT SSet RT Dose RT SSet RT Plan RT Dose Reference s Patient Registrar Multi-Media Registration Contouring Reference Point Generation Prescription Entry Beam Placer / Shaper Dose Calculator Plan Evaluator Fractionator Reference Creator -RO Treatment Delivery -RO Technical Frameworks 11

12 Actors -RO Connectathon 2006 Contourer Geometric Planner Dosimetric Planner Dose Displayer Participants Phillips Siemens Nucletron Varian Elekta Brainlab Tomotherapy CMS IMPAC Evaluators Bruce Curran (U Mich) Walter Bosch (Wash U ATC) Chuck Pelizzari (U Chicago) Philip Devlin (Harvard) Supporters Keith La Plain (Varian) Stuart Swerdloff (IMPAC) Robyn Watson (ASTRO) Jamie Gale (ASTRO) Mike Sullivan (ASTRO) Amy Kapinus (ASTRO) Stephen Vastagh (NEMA) Informal Connectathon participants, 9 Vendors, 10+ systems 95+ monitored test cases Informal Connectathon

13 What s Next? Compositing Dose Residual Dose Optimization Multimodality Registration On-line Review (reference image vs. delivery image) Off-line Review (reference image vs. delivery image) Scheduling Treatment Delivery and Verify/Record Query/Retrieve Configuration Management Profile Roadmap Initial Implementation ( ) RO General Integration Profile CT Retrieval / Storage Set Contouring Geometric Plan Definition Dosimetric Plan Definition 3D Dose Matrix Viewer Reduce Multiplicity of Implementation Paths Test Tools Contract in place Connectathon Scheduled (8/25/2007) 2008 Profiles RO Multimodality Registration Treatment Delivery Workflow Selected for RO 2006 Connectathon 13