Evolution of Image Sharing:
A long and winding road
Elliot Silver, M.Sc.
Senior Standards Analyst
Evolution of Image Sharing
Problem Statement
Radiology imaging has been
independent of the primary electronic
patient record.
However, clinicians increasingly
need access to the patient’s
longitudinal record including clinical
documents as well as imaging.
Evolution of Image Sharing
Focus
• DICOM
• XDS-I
• DICOMweb
• FHIR
• A Way Forward
Evolution of Image Sharing
DICOM®
• For medical imaging, the standard is DICOM
(Digital Imaging and Communications in Medicine)
– Specialized file formats and network protocols
for storing, querying, retrieving, and managing
images and imaging workflows
– Targeted departmental imaging needs
– Requires DICOM-aware viewing systems
– Poor “ad hoc” viewing/sharing capabilities
– Largely independent of the HIS or EHR
DICOM is a registered trademark of the National Electrical Manufacturers Association
Evolution of Image Sharing
Classical DICOM sharing
• Print and Scan
– Source prints films; recipient may scan
• DICOM media
– CD, USB, etc.
• Reference Web Viewers
– DICOM-aware web applications,
typically provided by PACS vendor
• Point-to-Point Sending
– Proprietary solutions to send imaging
over the Internet
Evolution of Image Sharing
IHE Cross-Enterprise Document Sharing for Imaging (XDS-I)
• Based on IHE’s Cross-Enterprise Document Sharing (XDS) profile
• Images can be retrieved over web as JPEG, etc.
• Allows imaging to easily cross organizational boundaries
• Still requires consumer to be DICOM aware
Evolution of Image Sharing
DICOMweb
• Additional DICOM capabilities based on popular RESTful paradigm
DICOM
object retrieve
DICOM
object storage
DICOM
object query
DICOM
workflow
WADO-RS
STOW-RS
QIDO-RS
UPS-RS
Evolution of Image Sharing
HL7® FHIR® (Fast Healthcare Interoperable Resources)
• Next generation standard from HL7
• Nearing second draft release (DSTU2);
targeting normative release in 2017
• Modern, web-friendly design;
focus on ease of implementation
• RESTful (plus others) model
• Feeling in community that FHIR
will supplant HL7 v2 and v3
within 5-10 years
HL7 and FHIR are registered trademarks of Health Level Seven International.
Evolution of Image Sharing
HL7 FHIR Imaging Resources
• Resources to represent key DICOM study
information (including image references) and
selected images
• Image references are (WADO-RS) URLs
– No need to know DICOM to display
images, etc.
• Imaging resources like other FHIR resources
– No need to know DICOM query or Key
Object Selection file structure to find
images
• Allows access to imaging by non-imaging
aware applications
Evolution of Image Sharing
Imaging-Integrated Health Record
Influence
Access
Integrate
How will integrating
imaging influence care
delivery cost and quality?
Who will access this
integrated record, and
where?
What does an
integrated record
look like?
Evolution of Image Sharing
The Road Ahead
• The evolution of FHIR and
DICOMweb are giving us a map.
• We are at a critical inflection point.
• As a community, we can define the
road we take to integrated imaging.
Thank You
www.mckesson.com
Elliot Silver, M.Sc.
Senior Standards Analyst