GE Healthcare
Sharing Images without CDs,
The Next Imaging Sea Change
Chris Lindop
GE Healthcare
Interoperability & Standards
Slide 1
In the Beginning:
Film
Film – the First Standard for Image
Exchange
In the beginning….
• open image exchange started with one reliable method:
FILM
Advantage:
• Everyone can view the Film
Issue: to be solved:
• Inconsistent visual quality
• Annotations, notes, etc. were attached “stuck-on”
IHE Solution:
• Consistent Presentation of Images (CPI) Integration Profile
– Grayscale Standard Display Function (consistent
images)
– Grayscale Softcopy Presentation State (Annotations)
Radiology Enters the Digital
Image Exchange:
Portable Media: CDs
Portable Media– the next interop challenge
CDs or coasters?
• Then came the introduction of CDs and other portable media,
but for most, was simply coasters for your morning coffee.
Issues to be solve:
• Media in-compatibility
• Inconsistent viewer capabilities
• No import method to reviewer’s view station
IHE Solution:
• Portable Data for Imaging (PDI) – Standard media format
• Basic Image Review (BIR) – Basic Viewer capability
requirements
• Import Reconciliation Workflow (IRWF) – Standard import
method
Electronic Images Sharing
beyond your Institution
The Image Exchange
Use of a shared XDS Community-based infrastructure to
access Radiology Reports and Images (XDS-I)
Between Radiology and :
•
Imaging specialists
•
Non-imaging clinicians
•
Patients
Radiology
–to –
Physicians
Physician Practice
Hospital
PACS Y
Radiology
-toRadiology
PACS Z
Imaging Center
Specifies how Radiology Information Objects, Both DICOM Instances and non-DICOM
Reports are distributed in an eHealth Community
Slide 77 7
XDS Affinity Domain Considerations
• Set of organizations/systems
organized around a single Registry
• Common set of Codes
• Single Patient ID Domain
• Involves business and legal
agreements
• Security model/agreements
IHE Integration Profiles for Health Info Nets
What is available and in trial implementation
Clinical and PHR Content
Emergency Referrals
Format
of the Document Content
PHR
Extracts/Updates
and
associated
coded vocabulary
ObGyn
Documents
Format
of the
Document Content
and
associated
coded vocabulary
Lab
Results
Document
Format of the Document Content
Content
Scanned
Documents
and associated
coded vocabulary
Format of the Document Content
Format
of theInformation
Document
Imaging
and associated
coded Content
vocabulary
Medical
Format
of theSummary
Document Content
and(associated
codedPbs)
vocabulary
Meds, Allergies,
Format of the Document Content
and associated coded vocabulary
Security & Privacy
Basic Patients Privacy
Consents
Establish Consents & Enable
Access Control
Cross-Enterprise User
Assertion
Provides Trusted Identity
Document Digital
Signature
Patient ID Mgmt
Patient Demographics
Query
Patient Identifier
Cross-referencing
Map patient identifiers across
independent identification
domains
Attesting “true-copy and origin
Health Data Exchange
Cross-Enterprise
Document Sharing
Registration, distribution and access
across health enterprises of clinical
documents forming a longitudinal record
Cross-Enterprise Document
Pt-Pt Reliable Interchange
Cross-Enterprise Document
Media Interchange
Cross-Community Access
Final Text Approved
Audit Trail & Node
Authentication
Centralized privacy audit trail and node
to node authentication to create a
secured domain.
Consistent Time
Coordinate time across networked
systems
Other
Request Form
for Data Capture
External form with custom
import/export scripting
Document
Subscription and
Notification
Trial Implementation
Cross-Enterprise Document Sharing (XDS.b)
Actor/Transaction Diagram
Patient
Identity Source
Patient Identity
Feed
Document
Registry
Query
Documents
Register
Document Set
Document
Source
10
Provide&Register
Document Set
Document
Repository
Retrieve
Document Set
Document
Consumer
XDS-I.b Actors and Transactions
Pateint Identity
Source
Pateint Idenity Feed

Registry Stored Query

Document
Registry
(XDS.b)
Imaging Document
Consumer
 Register
Document Set – b
Provide & Register Imaging
Document Set – MTOM/XOP

Imaging
Document Source
Document Repository
(XDS.b)
Document Consumer
(XDS.b)
Retrieve Document
Set 
WADO Retrieve 
RAD-69 Retrieve Imaging Document Set 
Retrieve Images 
Retrieve Presentation States 
Retrieve Reports 
Retrieve Key Image Note 
Retrieve Evidence Documents 
Same XDS Infrastructure (Registry and
Repositories) for medical summaries and imaging
information !
Slide 11
Linking Report to Prior Images and Prior Repor
Document Registry
Submission
Set
1
Document
Entry
Submission
Set
2
Document
Entry
Submission
Set
3
Document
Entry
Document Repository
Submission
Set
4
Document
Entry
Cross-Enterprise Document Sharing
GP 2
Data Centre
Repository
Practice
Shared Storage
Services
GP 1
Enterprise
Practice
Enterprise
CrossEnterprise
Document
Registry
(XDS)
Imaging Center
Hospital A
Repository
Repository
Enterprise
Emergency Room
Hospital B
Admin
Patient
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Electronic Images Sharing
beyond …..
Cross-Community
Image Exchange
Cross-Community Access of Images
(XCA-I) the next Sea change
Foundational with Standards incl. DICOM Web services
– DICOM WADO-WS supp-148)
Interoperable with clinical portals
– Compatible with IHE Web services profiles, including Security
and privacy
Interoperable with PACs and vendor neutral archives
– Ready for cloud hosted apps
Why extend XDS?
XDS only addresses document sharing within
an XDS Affinity Domain
Cross-Community addresses the questions:
 How to share documents between XDS Affinity
Domains?
 How to share documents with non-XDS Affinity
Domains?
16
XCA Transaction Diagram
minimum required
R esp ond ing C o m m u n ity
In itiatin g C o m m u n ity
C ro ss G ate w a y
Q uery [IT I-3 8 ]
Initiatin g
G ate w a y
R esp o nd ing
G ate w a y
C ro ss G ate w a y
R etrieve [IT I-3 9 ]

17
XCA Transaction Diagram
R esp ond ing C o m m u n ity
In itiatin g C o m m u n ity
R egistry S to red
Q uery [IT I-1 8 ] 
X D S D o cu m e nt
C o nsu m er
D o cu m e nt
R egistry
R etrieve D o c u m e nt
S et [IT I-4 3 ] 
 R egistry S to red
Q uery [IT I-1 8 ]
C ro ss G ate w a y
Q uery [IT I-3 8 ]
D o cu m e nt
C o nsu m er
 R e gistry S to red
Q uery [IT I-1 8 ]
D o cu m e nt R egistry
Initiatin g
G ate w a y
 R etrieve D o c u m ent
S et [IT I-4 3 ]
D o cu m e nt R ep o sito ry
R esp o nd ing
G ate w a y
C ro ss G ate w a y
R etrieve [IT I-3 9 ]

D o cu m e nt
C o nsu m er
 R etrieve D o c u m ent
S et [IT I-4 3 ]
D o cu m e nt
R ep o sito ry
18
XCA-I Transaction Diagram
Initiating Community
XDS.b Document
Repository
5
 Retrieve
Document Set
[ITI-43]
XDS.b
Document
Consumer
10
Imaging
Document
Consumer
Responding Community
XDS.b Document
Registry
 Registry Stored
Query [ITI-18]
Registry Stored
Query [ITI-18] 
XCA
Initiating
Gateway
Retrieve
Registry
Stored Query
Document Set
[ITI-18] 
[ITI-43] 
Initiating
Imaging
Gateway
XDS.b Document
Registry
XDS.b Document
Repository
 Registry Stored
Query [ITI-18]
 Retrieve
Document Set
[ITI-43]
Cross Gateway
Query [ITI-38]
Cross Gateway
Retrieve [ITI-39] 
Cross Gateway Retrieve
Imaging Document Set
[RAD-75]
XCA
Responding
Gateway
Responding
Imaging
Gateway
Retrieve Imaging Document Set
[RAD-69] 
Retrieve Imaging Document Set[RAD-69]
Imaging Document
Source
15
XCA-I
Foundational with Standards incl. DICOM Webservices
– DICOM WADO-WS supp-148)
Interoperable with clinical portals
– Compatible with XDS.b, XUA, ATNA
Interoperable with PACs and vendor neutral archives
– Compatible with XDS-I.b, DICOM-WS
– Ready for cloud hosted apps
Imaging Object Change Management
(IOCM)
IOCM specifies how to communicate changes applied on
existing imaging objects to other systems. Changes include
(1) rejection due to quality or patient safety reasons,
(2) correction of incorrect modality worklist entry selection,
(3) expiration due to data retention requirements.
IOCM is fully compatible with existing profiles!
Providers and Vendors
Working Together to Deliver
Interoperable Health Information Systems
in the Enterprise
and Across Care Settings
http://www.ihe.net
http://www.ihe.net.au
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