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MINUTES
DICOM WORKING GROUP TWENTY
(Integration of Imaging and Information Systems)
and
HL7 IMAGING INTEGRATION WORK GROUP
Date:
May 7-8, 2013
Place:
HL7 Meetings
Sheraton Hotel
Atlanta, Georgia
Members Present
Represented by
GE Healthcare
Siemens Healthcare
Solomon, Harry
Koenig, Helmut
Members Absent
Voting Representative
CoreLab
Merge Healthcare
Philips Healthcare
Clunie, D. *
Cowan, Ron *
Jeroen Medema
Others Present
Affiliated with
Brett Marquard
River Rock Associates
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Minutes - DICOM WG-20, May 7-8, 2013
Page 159
Beebe, Calvin
Brodsky, Victor
Constable, Lorraine
Hartveit, Lars-Gunnar
J.D. Nolen
Loyd, Patrick
Marquard, Brett
Shabo, Amnon
Vastagh, Stephen
Presiding Officers
SD Co-Chail/Mayo Clinic
AP Co-Chair /College of American Pathologists
OO Co-Chair/Constable Consulting
HL7-Norway
AP Co-Chair/Cerner
OO Co-Chair
SD Co-Chair/River Rock Associates
CG Co-Chair/IBM, Haifa
MITA
Helmut Koenig, Siemens, Co-Chair
Harry Solomon, GE Healthcare, Co-Chair
1. Opening

The meeting was called to order at 09.00. The antitrust rules were reviewed

The agenda and previous minutes were approved.

HL7 “Work Group Health” is rated green.

T-cons of WG-20/II, WG-08, HL7; they were cross-posted and HL7 II members were
invited. The t-cons were not recorded in the HL7 calendar. (H. Koenig will check on
this.)

Review project dates in 3-year plan
o CMET project removed, no longer necessary, no longer used in the context of v3
messages
o
Added HL7 FHIR as a project
o WADO Sup 148 completed, removed
The revised plan will be posted in the meeting folder.
2. RSNA Imaging Template Project
This is an ongoing project in cooperation with DICOM WG-08.
The purpose of the project is to update the CDA DIR IG (RSNA Templates) and manage same through
the DICOM process. The process and planned action steps have been reviewed at the previous meeting.
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Minutes - DICOM WG-20, May 7-8, 2013
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The RSNA radiology reporting initiative has already gathered over 200 templates, mostly for narrative
content, but also for some quantitative and codified findings.
The Group discussed at length how the RSNA templates can be used as a resource and format for HL7
CDA templates.
A model was developed and proposed by H. Koenig for the CDA implementation guide. It addresses
the patterns in the RSNA report templates’ finding sections. The goals are to specify a structured
representation for those findings.
Analyzed various templates across the subspecialty templates of RSNA. Reviewed chest imaging,
cardiac imaging, interventional procedures and neuroradiology templates. Concluded that the above
model would be suitable to represent the patterns.
The model is a structured representation of the findings rather than only narrative text of the finding
sections. This can lead to greater accuracy and much improved efficiency. This is a great difference in
quality. An example from Norway of the potential increase of efficiency for physicians was provided.
Potential issues that emerged in the discussion included were:
o Some procedures may be identified by more than one codes
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Minutes - DICOM WG-20, May 7-8, 2013
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o Some procedures are over a period of more than one day (observations from each day) –
temporal designations for individual days or sectional division. Textual designation of multi day
procedures may be added. Alternatively “effective time” may be added in the assertion.
o Distinction between planned (and ordered) and performed procedures
As the above model is finalized, it will represent a large step toward the completion of this project.
The Group discussed the Model in more details:

Assertion – RSNA templates may use assertion for basic observations

Potentially would create structured entries only for key data included in the RSNA templates (if
so key data elements need to be defined)

Radlex codes might primarily be used as labels in CDA section.text (narrative). Harry Solomon
suggested that structured elements would rather use LOINC or SNOMED codes.,
3. Supplement 155 (Templates for Imaging Procedure Reports encoded in CDA)
DICOM will publish the CDA DIR Implementation Guide R2 (update to the HL7 DIR IG R1;
DICOM Work Item 2010-04-D, to be published as Supplement 155) and will allow for linkage and
inclusion of sub-specialty templates in the appropriate document sections. That subspecialty content
is being developed through the RSNA radiology reporting initiative. (DICOM WG-08 will
cooperate with WG-20.)
Sup 155 is not dependent on completion of the universal realm IG.
Target date:
Oct. 14, 2013 WG-06 – Arlington, VA – Joint presentation with WG-08
Sup 155 is the CDA DIR Implementation Guide release 2.
Co-editors of the CDA DIR Implementation Guide will be Fred Behlen (ACR), Charles Kahn
(ACR), Helmut Koenig (Siemens) and Harry Solomon (GE) Lars-Gunnar Hartveit (Norway)
May be balloted through HL7, as well.
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Minutes - DICOM WG-20, May 7-8, 2013
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4. Jt. Mtg with HL7 Anatomic Pathology (AP), Orders & Observations (O&O) and Clinical
Genomics (Clin Gen)
WG-20/IIWG joined the HL7 OO, AP and CG for a joint meeting. Formally, the joint meeting
was hosted by OO, and therefore the O&O minutes are the official record.
The joint meeting consisted of reports by AP, O&O, and II.
No new business was brought before the Joint Meeting.
5. Jt. Mtg with HL7 Structured Documents
WG-20/IIWG joined the HL7 Structured Documents Work Group (SD) Work Group for a joint
meeting. Formally, the joint meeting was hosted by SD, and therefore its minutes are official; a
summary of the discussion is provided here.
The following topics were discussed:


Universal realm consolidated CDA IG
CDA IG separation of structure and vocabulary

CDA tooling and publication format for intensive use of Level 3 content

Revision of Basic Diagnostic Imaging Report (Universal Realm), DICOM Supplement 155 and
RSNA templates
--II reported on the ongoing work of leveraging on the RSNA templates and
restated intent to create Universal template that would go beyond US requirements!

CDA IG ballot quality
--SD re-emphasized the requirements they set and the need to conform thereto.
Reference was made to the HL7 minimum requirements (HL7 wiki page.) A
subgroup was established in SD to monitor quality.


Update on status of CDA R3 (R3 for imaging reports)
--HL7 will have to recreate templates??
At one time wanted to support only clinical statement model.
issue….
SD will deal with this
CDA RMIM ROI – HL7 prefers to deprecate ROI. DICOM agrees.
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Minutes - DICOM WG-20, May 7-8, 2013
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
CDA RMIM Responsible Party –HL7 intends to deprecate it. DICOM agrees.

Question to II by SD about FHIR, acceptance, use?
--Answer: DICOM is coordinating with HL7 FHIR – had such understanding between
DICOM and FHIR since September 2012 (Baltimore). DICOM is in favor of
harmonizing, will not develop its own patient resource.
6. Next Meetings
Next meeting with HL7:
The next joint meetings between DICOM and HL7, and the WG-20 meetings will be held ,
during September 22-27, 2013, during the 27th Annual Meeting in the Hyatt Regency,
Cambridge, MA.
Preliminary Schedule:
Tue- 9/24
Wednesday, 9/25
Q1 - Joint Mtgs with O&O, AP (Q1Wed), and SD
Q3 – Joint with SD
Thursday, 9/26 PM Harry teaches Q3-Q4
Q1-Q2 Joint WG-20&27
Q3-Q4 Joint DICOM-FHIR (To Be Confirmed)
Future Meetings with HL7:
Jan. 12-17, 2014 – HL7 Working Group Meetings
Hilton in the Walt Disney World Resort, Lake Buena Vista, FL
Sept. 14-19, 2014 - 28th HL7 Annual Plenary and Working Group Meetings
Hilton Chicago Hotel, Chicago, IL
Jan. 18-23, 2015 – HL7 Working Group Meetings
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Minutes - DICOM WG-20, May 7-8, 2013
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Hyatt Regency Riverwalk, San Antonio, TX
Oct. 4-5, 2015 - 29th HL7 Annual Plenary and Working Group Meetings
Sheraton Atlanta Hotel, Atlanta, GA
7. Adjournment
The meeting was adjourned at 17.00 on May 9.
Reported by
Stephen Vastagh
Secretary
Reviewed by: CRS
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