HL 7 DICOM. Health Level 7. Digital Imaging and Communication in Medicine. Telemedizin WS 08/09 HL7 -DICOM -1. Worzyk FH Anhalt

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1 HL 7 Health Level 7 DICOM Digital Imaging and Communication in Medicine HL7 -DICOM -1 1

2 Communication in a hospital Administration Radiologie Laboratory surgery documentation HL7 -DICOM -2 2

3 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 HL7 -DICOM -3 3

4 HL7 HL7 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. HL7 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. HL7 -DICOM -4 4

5 Communication with HL7 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 HL7 -DICOM -5 Formate: Darstellungsvorschrift z.b. für Datum, Uhrzeit, Namen, Messwerte Protokolle: Regelung der Übertragung, z.b.: - Anfrage, ob der Empfänger bereit ist - Antwort, dass der Empfänger bereit ist - Übertragung der Daten - Quittung von Empfänger über die erhaltenen Daten - Mitteilung vom Sender 5

6 Messages Aufnahme, Verlegung, Entlassung (admission, discharge, transfer = ADT) Anfragen (queries) Untersuchungsergebnisse (result reports) Buchhaltung / Finanzen (finance) Patientenversorgung (patient care) Terminplanung (scheduling) Rezept (pharmacy prescription) HL7 -DICOM -6 6

7 Events The transmission of the messages is triggered by events Example: A01 stationäre Aufnahme Admit A02 Verlegung Transfer A03 Entlassung Discharge A08 Änderung Update HL7 -DICOM -7 7

8 Example Administration A01 Radiologie A01 ACK A01 ACK Laboratory ACK surgery documentation HL7 -DICOM -8 The patient is admitted into the hospital The admission programm sends a message A01 to the involved units. They answer with the ACK-message to signal that they have received the messsage 8

9 Example Administration query message Patient unknown response message Laboratory HL7 -DICOM -9 A sample is arrived in the laboratory. The patient is unknown to the laboratory computer. The laboratory computer sends a query message to the administration computer The administration computer sends a response message including the patient data to the laboratory 9

10 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 HL7 -DICOM -10 Nachrichten sind die kleinsten übermittelbaren Einheiten 10

11 ST Datatypes of fields String XPN Person Name TX Text XAD Adresse FT Formatted Text XTN Telefon Number NM Numeric ID Coded Value HL7 table DT TS Date Timestamp IS CN Coded Value user defined Composite PL Person Location HL7 -DICOM

12 Example of Codetabelle Attributwert F M O U Description Female Male Other Unknown Bezeichnung weiblich männlich andere unbekannt HL7 -DICOM

13 A01 ADMIT A PATIENT MSH Message Header EVN Event Type PID Patient Identification [PD1] Additional Demographics [ { NK1 } ] Next of Kin /Associated Parties PV1 Patient Visit [ PV2 ] Patient Visit - Additional Info. [ { DB1 } ] Disability Information [ { OBX } ] Observation/Result [ { AL1 } ] Allergy Information [ { DG1 } ] Diagnosis Information [ DRG ] Diagnosis Related Group [ { --- PROCEDURE begin PR1 Procedures [{ROL}] Role } ] --- PROCEDURE end [ { GT1 } ] Guaranto [ { --- INSURANCE begin IN1 Insurance [ IN2 ] Insurance Additional Info. [ {IN3} ] Insurance Additional Info. - Cert. } ] --- INSURANCE end HL7 -DICOM

14 Notation of Cardinality HL7 -DICOM

15 Segments Used in DUMC ADT Messages AL1 DG1 EVN MRG MSH NK1 OBX PID PV1 PV2 ZAP ZID ZV1 Allergy Information Diagnosis Information Event Type Merge Information Message Header Next of Kin Observation Patient Identification Patient Visit Patient Visit - Additional Information DUMC Appointment Segment DUMC Patient Identification Extension DUMC Patient Visit Extension HL7 -DICOM -15 Beispiele des Duke University Medical Center 15

16 Example ADT message admission of patients A01 - Admit a Patient MSH ^~\& DMCADT RADIS ADT^A01 DMCAD T P 2.2 NE EVN A MCKEL003 PID H89213 BOOP^BETTY^B F JOHN WRIGHT W 3380 HIDDEN OAK AVE^^DURHAM^NC^27704 (919) U UNK PV1 I MIN^2411^ ^MASSEY^E^WAYNE MRH C A 027 A ZV1 S I N DG1 CAUDA EQUINA SYN. W DG1 CAUDA EQUINA SYN. A DUMC HL7 ADT Specifications HL7 -DICOM -16 PID wird in beschrieben DUMC HL7 ADT Specifications ist im Netz nicht mehr zu finden 16

17 HL7 with XML Simpler to read Simpler to validate Bute the messages are much more longer Example : ADT - A01 message 500 characters ADT - A01 as XML 2127 characters Example HL7 -DICOM

18 CDA Clinical Document Architecture Document Hierarchy Level 1 Unconstrained CDA Header Body General dianostic finding Level 2 Section Level templates Header Body Header Body Header Body X - rax finding ECG finding Endoscopy finding Level 3 Entry Level templates Header Body Header Body Header Body Header Body Header Body X - rax CT MRT gastro oesophago HL7 -DICOM

19 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. HL7 -DICOM

20 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 HL7 -DICOM -20 Beschreibt den Umfang der implementierten Standards: Stellt eine Sprache zur Verfügung, mit der teilnehmende Systeme die bereitgestellten Dienste beschreiben können. 20

21 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 HL7 -DICOM -21 Information Object Definition: Definition einiger Klassen von Informationsobjekten, die die Objekte beschreiben, die für die Kommunikation digitaler medizinischer Bilder und den damit zusammenhängenden Informationen benötigt werden, z.b. Berichte, Strahlendosen usw. Jede Klassendefinition besteht aus der Beschreibung ihres Zwecks und der Beschreibung der Attribute, die diese Klasse definieren. Es werden zwei Arten von Klassen definiert: normalisierte Klassen enthalten nur die Attribute, die in der realen Welt in dieser Information vorhanden sind, z.b die Beschreibung einer Studie oder CT Bild. zusammengesetzte Klassen enthalten enthalten zusätzliche Informationen wir z.b. die Patienteninformationen, die zu einem CT Bild hinzugefügt werden. 21

22 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 HL7 -DICOM -22 Service Class Specifications: Eine Serviceklasse verbindet eine oder mehrere Informationsobjekte mit Befehlen, die auf diese Objekte einwirken. Die Spezifikationen der Serviceklassen beschreiben Anforderungen an die Befehle und wie die Befehle auf die Objekte einwirken. Sie beschreiben die Anforderungen sowohl für die Diensteanbieter als auch für die Nutzer. Beispiele: Storage Service Class Query/Retrieve Service Class basic Worklist Management Service Class Print Management Service Class 22

23 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) HL7 -DICOM -23 PS 3.6: DATA DICTIONARY PS 3.6 of the DICOM Standard is the centralized registry which defines the collection of all DICOM Data Elements available to represent information, along with elements utilized for interchangeable media encoding and a list of uniquely identified items that are assigned by DICOM. For each element, PS 3.6 specifies: its unique tag, which consists of a group and element number itsname its value representation (character string, integer, etc) its value multiplicity (how many values per attribute) whether it is retired For each uniquely identified item, PS 3.6 specifies: its unique value, which is numeric with multiple components separated by decimal points and limited to 64 characters itsname its type, either Information Object Class, definition of encoding for data transfer, or certain well known Information Object Instances in which part of the DICOM Standard it is defined 23

24 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 HL7 -DICOM -24 PS 3.5: DATA STRUCTURE AND SEMANTICS PS 3.5 of the DICOM Standard specifies how DICOM applications construct and encode the Data Set information resulting from the use of the Information Objects and Services Classes defined in PS 3.3 and PS 3.4 of the DICOM Standard. The support of a number of standard image compression techniques (e.g., JPEG lossless and lossy) is specified. PS 3.5 addresses the encoding rules necessary to construct a Data Stream to be conveyed in a Message as specified in PS 3.7 of the DICOM Standard. This Data Stream is produced from the collection of Data Elements making up the Data Set. PS 3.5 also defines the semantics of a number of generic functions that are common to many Information Objects. PS 3.5 defines the encoding rules for international character sets used within DICOM. 24

25 Standards Message Exchange specifies both the service and protocol used by an application in a medical imaging environment to exchange Messages HL7 -DICOM

26 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. HL7 -DICOM -26 PS 3.7: MESSAGE EXCHANGE PS 3.7 of the DICOM Standard specifies both the service and protocol used by an application in a medical imaging environment to exchange Messages over the communications support services defined in PS 3.8. A Message is composed of a Command Stream defined in PS 3.7 followed by an optional Data Stream as defined in PS 3.5. PS 3.7 specifies: the operations and notifications (DIMSE Services) made available to Service Classes defined in PS 3.4, rules to establish and terminate associations provided by the communications support specified in PS 3.8, 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. 26

27 Standards Network Communication Support Media Storage and File Format HL7 -DICOM

28 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 HL7 -DICOM -28 PS 3.11: MEDIA STORAGE APPLICATION PROFILES PS 3.11 of the DICOM Standard specifies application specific subsets of the DICOM Standard to which an implementation may claim conformance. These application specific subsets will be referred to as Application Profiles in this section. Such a conformance statement applies to the interoperable interchange of medical images and related information on storage media for specific clinical uses. It follows the framework, defined in PS 3.10, for the interhcange of various types of information on storage media. An Application Profile annex is organized into the following major parts: a) The name of the Application Profile, or the list of Application Profiles grouped in a related class b) A description of the clinical context of the Application Profile c) The definition of the media storage Service Class with the device roles for the Application Profile and associated options d) Informative section describing the operatinal requirements of the Application Profile e) Specification of the Information Object Classes and associated Information Objects supported and the encoding to be used for the data transfer f) The selection of media formats and physical media to be used g) Other parameters which need to be specified to ensure interoperable media interchange h) Security parameters which select the cryptographic techniques to be used with secure media storage Application Profiles The structure of DICOM and the design of the Application Profile mechanism is such that extension to additional Information Object Classes and the new exchange media is straightforward. 28

29 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. HL7 -DICOM

30 Standards Conformance defines principles that implementations claiming conformance to thestandard shall follow specifies the general requirements which must be met by any implementation claiming conformance. defines the structure of a Conformance Statement. HL7 -DICOM -30 PS 3.2: CONFORMANCE PS 3.2 of the DICOM Standard defines principles that implementations claiming conformance to the Standard shall follow: Conformance requirements. PS 3.2 specifies the general requirements which must be met by any implementation claiming conformance. It references the conformance sections of other parts of the Standard. Conformance Statement. PS 3.2 defines the structure of a Conformance Statement. It specifies the information which must be present in a Conformance Statement. It references the Conformance Statement sections of other parts of the Standard. 30

31 Standards HL7 -DICOM -31 Conformance: Anforderungen an die Konformität, die eine Installation erfüllen muß, wenn sie erklärt, sich konform zu verhalten. Definition des Befehls, mit dem die Konformität erklärt wird. 31

32 Examples PACS Picture Archiving and Communication System RIS Radiologie Information System oentgendiagnostik/index.php Integration tenmanagement.pdf HL7 -DICOM