High Level Health IT (HIT) Standards for Ophthalmologists worldwide DICOM : the comprehensive ifa Solutions (Digital Imaging and Communication in Medicine) 1
1 2 3 4 5 6 7 8 Overview Introduction and DICOM in ophthalmology The ifa DICOM solutions DICOM connectivity with hospital level (HIS/PACS) DICOM connectivity with modality level (ophthalmic equipment) DICOM Quick Specifications for the specialists Projects with DICOM solutions Conclusion 2
Introduction and DICOM in Ophtalmology DICOM (Digital Imaging and Communication in Medicine) is the most comprehensive open standard in Health IT. DICOM covers digital management of images and related objects: http://medical.nema.org/dicom/geninfo/strategy.pdf DICOM is defined e.g. as the official standard for images and related objects by the US Government. Within IHE (Integrating the Healthcare Enterprise) DICOM covers essential format and work flow components. DICOM plays an important role for IT in ophthalmology. The DICOM work group 9 (WG 9) works dedicated to ophthalmology and optometry since 1996. The WG 9 is supported and coordinated by the AAO. 3
The ifa DICOM portfolio Connectivity is most important for Health IT (HIT) in ophthalmology The 3 DICOM solutions in the ifa portfolio: PREMIUM EMR with the complete DICOM modules (hospital and modality levels) ecpacs the DICOM connectors between EMR and ophthalmic devices net4eyes the back office solution for DICOM services 4
All important Data Objects in Ophthalmology are covered Service Object Pairs (SOPs) are Message Service Elements (DIMSE) and Information Object Definition (IOD) SOP Classes Ophthalmic Modalities 1.2.840.10008.5.1.4.1.1) Lensometer Measurements (78.1) Autorefraction Measurements (78.2) Keratometry Measurements (78.3) Subjective Refraction Measurements (78.4) Visual Acuity Measurements (78.5) Spectacle Prescription Report (78.6) SOP Classes Images + PDF(1.2.840.10008.5.1.4.1.1) Secondary Capture Image Storage (7) VL Photographic Image Storage (77.1.4) Ultrasound Image Storage (6.1) Ultrasound Mult-Frame Image Storage (3.1) Ophthamic 8 bit Photography Image Storage (77.1.5.1) Ophthalmic Tomography Image Storage (77.1.5.4 Encapsuled PDF Storage (104.1) 5
All in One: the complete portfolio Images and Instrument Data All in One System The interfaces are based on international standards: HL7 to connect Hospital Information Systems DICOM to integrate all kind of image systems and laser diagnostic devices IHE approved 6
The Electronic Medical Record: PREMIUM EMR The paperless hospital: DICOM plays a central role with all related SOPs
IHE Eye Care: Integrating the Healthcare Enterprise
Connectivity with Hospital Level Product quick facts Product name: ifa DICOM Gateway First release date: November 2013 Number of installations: 2 Product status: Active Based on IAG 3rd generation DICOM Connection Module, MultiTech DICOM SDK and LeadTools File Codecs V17 using.net Framework 3.5x and C++ V10 Fully integrated into ifa Core Executed via Scheduled Tasks
Product Features Patient Demographics Import DICOM Modality Worklist can be used to establish a patient with the ifa Patient Demographics module. This feature is used if the HIS Patient Demographics Provider cannot be configured to only communicate Ophthalmic department related patients. As the patient demographics information received via the DICOM Modality Worklist are not complete the ifa HL7 Patient Demographics Consumer can be configured to ignore patients not established via the DICOM Modality Worklist interface but only update patients already existing in the Demographics DB with all data available from the ADT message.
DICOM Instance Management If the PACS provides DICOM Study level related information like Accession Nr. and Study Instance UID through the DICOM Modality Worklist (MWL)these data are stored by the DCM Instance Management Module. If the data are missing the module is creating the data on the fly. These data are used later creating the IOD if transferring information to the PACS (together with patient demographics data and Scheduled Procedure Step data).
Workflow Management and Document Export Workflow Management (not yet available) If the PACS provides Scheduled Procedure Step information through the DICOM Modality Worklist these data are interfaced with the ifa Workflow Management Module Document Export The app check for changes with the File DB and creates for each new/updated document the corresponding IOD by combining the image or PDF data taken from the document file with data from Patient Demographics, Workflow Mgt. and DICOM Instance Mgt. DBs and uploads the resulting IOD to the PACS.
Connectivity with Modality Level Product quick facts Product: ifa CCS Gateway First release date: July 2009 Number of installations: 5 Product status: In Transition (needs to be migrated to IAG 3rd generation DICOM Connection Module) Based on IAG 2nd generation DICOM Connection Module, MultiTech DICOM SDK, using.net Framework 3.5x and C++ V10 Mostly integrated into ifa framework Executed via Windows Services
Product features and Workflow Management Patient Demographics Export The app uses the Modality Worklist to provide devices with a copy of the patient demographics data from the Patient Demographics DB. Workflow Management The app provide orders to devices based on a flexible configuration linking devices/device groups with Workflow Management Slots/Grouped Slots. The device operator can ask the Application Modality Importer (AMI) software/device Software to display a Worklist Dialog which shows the patients/orders scheduled for the specific device or for the device group the specific device is contained.
Document Import and Workflow Advance The app can import results of the device operation into the File DB. The device operator can select the documents related to a patient/order (see Worklist Dialog with Workflow Management description) and ask the Application Modality Importer (AMI) software/device Software to use the Storage service to upload the data to ifa. If configured the app will mark the Workflow Management Workflow Step related to the Worklist order related to the document upload as done and has Workflow Management advancing the workflow.
Connectivity with PACS Product quick facts Product: ifa DICOM Query-Retrieve Interface and DICOM Document Viewer First release date: October 2011 Number of installations: Demonstrator for IHE events (AAO) Product status: pilot version Based on IAG 3rd generation DICOM Connection Module, MultiTech DICOM SDK, using.net Framework 3.5x and C++ V10 Executed via Windows Services
Connectivity with a PACS (e.g. Multispecialty)
DICOM Quick Specifications (1) Generell Supported Transfer Syntaxes Transfer Syntax Name Transfer Syntax UID Role LittleEndianImplicit 1.2.840.10008.1.2 SCU/SCP LittleEndianExplicit 1.2.840.10008.1.2.1 SCU/SCP BigEndianExplicit 1.2.840.10008.1.2.2 SCU/SCP Verification Supported SOP Classes SOP Class Name SOP Class UID Role Verification 1.2.840.10008.1.1 SCU/SCP
DICOM Quick Specifications (2) Modality Worklist (C-Find) Supported SOP Classes SOP Class Name SOP Class UID Role Modality Worklist Information Model - Find 1.2.840.10008.5.1.4.31 SCU/SCP Retrieve / Send Documents (C-Store) Additional supported Transfer Syntaxes (Image IODs) Transfer Syntax Name Transfer Syntax UID Role JpegBaseline 1.2.840.10008.1.2.4.50 SCU/SCP Jpeg2kLossless 1.2.840.10008.1.2.4.90 SCU/SCP Jpeg2kLossy 1.2.840.10008.1.2.4.91 SCU/SCP
DICOM Quick Specifications (3) Retrieve/Send Documents (C-Store) Supported SOP Classes Images IODs SOP Class Name SOP Class UID Role Secondary Capture Image Storage 1.2.840.10008.5.1.4.1.1.7 SCU/SCP VL Photographic Image Storage 1.2.840.10008.5.1.4.1.1.77.1.4 SCU/SCP Ultrasound Image Storage 1.2.840.10008.5.1.4.1.1.6.1 SCU/SCP Ultrasound Multi-frame Image Storage 1.2.840.10008.5.1.4.1.1.3.1 SCU/SCP Ophthalmic 8 bit Photography Image Storage 1.2.840.10008.5.1.4.1.1.77.1.5.1 SCU/SCP Ophthalmic Tomography Image Storage 1.2.840.10008.5.1.4.1.1.77.1.5.4 SCU/SCP
DICOM Quick Specifications (4) Retrieve/Send Documents (C-Store) Supported SOP Classes other IODs SOP Class Name SOP Class UID Role Encapsulated PDF Storage 1.2.840.10008.5.1.4.1.1.104.1 SCU/SCP Lensometry Measurements LEN 1.2.840.10008.5.1.4.1.1.78.1 SCU/SCP Autorefraction Measurements AR 1.2.840.10008.5.1.4.1.1.78.2 SCU/SCP Keratometry Measurements KER 1.2.840.10008.5.1.4.1.1.78.3 SCU/SCP Subjective Refraction Measurements SRF 1.2.840.10008.5.1.4.1.1.78.4 SCU/SCP Visual Acuity Measurements VA 1.2.840.10008.5.1.4.1.1.78.5 SCU/SCP Spectacle Prescription Report 1.2.840.10008.5.1.4.1.1.78.6 SCU/SCP
DICOM Quick Specifications (5) Query Documents (C-Query) Supported SOP Classes SOP Class Name SOP Class UID Role Patient Root Query/Retrieve Information Model Find Study Root Query/Retrieve Information Model Find 1.2.840.10008.5.1.4.1.2.1.1 SCU 1.2.840.10008.5.1.4.1.2.2.1 SCU Request Documents (C-Move) Supported SOP Classes SOP Class Name SOP Class UID Role Patient Root Query/Retrieve Information Model Move Study Root Query/Retrieve Information Model Move 1.2.840.10008.5.1.4.1.2.1.2 SCU 1.2.840.10008.5.1.4.1.2.2.2 SCU
Conclusion Health IT Investments are Matter of Trust The first ifa company for IT in eye care was founded 1984 in Cologne/Germany. Since more than 30 years the ifa product specialists develop, distribute and support IT connectivity tools worldwide. The ifa portfolio covers basic back office interface suites and also complete EMR systems dedicated to ophthalomolgy. DICOM is an integral part of the ifa product concept since 1996. Together with the complementary HL7 components the IHE world can be implemented with the structured ifa product and service portfolio.
How to get started? The ifa group offers DICOM solutions worldwide The first step is a detailed system and project analysis (see project profile). Based on the project profiles with detailed information about the modalities (equipment) and HIS infrastructure ifa provides the cost estimation with all technical specifications. The cost estimation can be based on a license purchase model or on a RAS Rent A Software concept. The final contract specifies the project plan based on QM driven processes (ISO 9001) and the related DICOM Conformance Statement. The ifa DICOM solutions are covered by connectivity guarantees for the future. The interface list 2015 offers connectivity for more than 450 modalities in eye care. The ifa product specialists are active members of DICOM WG9 and the IHE committee.
DICOM Glossary Code/Text Description AAO American Academy for Ophthalmology, DICOM Sponsor WG 9 AMI Application Modality Importer DIMSE DICOM Message Service Element HL7 Health Level 7 (HL7 and DICOM are both IHE related Health IT Standards) IHE Integrating the Healthcare Enterprise IOD Information Object Definition Modality Medical Device in the DICOM Dictionary MWL Modality Worklist NEMA National Electric Manufactorers Association, official DICOM coordinator PACS Picture Archive and Communication System SCP Service Class Provider SCU Service Class User SOP Service Object Pair WG9 DICOM Workgroup 9 Ophthalmology (coordinated by AAO) VL Visible Light (Term for traditional Photography, e.g. Fundus Photos)
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