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M I N U T E S
Members Present (WG 20):
American College of Radiology
Brown, Nicholas (MIMIC)
GE Healthcare
Philips Medical Systems
Siemens Medical Solutions
Members Present (HL7):
Liora Alschuler – T
Patty Anderson – W
Yongjian Bao – T, W
Calvin Bebe – T
Bruce Beckwith – W
Doug Bogin – W
Keith Boone – T
Joel Chabriais – T
Christel Daniel-Le Bozec – W
Michael Descour – W
Robert Dolin – T
Shashi Duraiswami – T
John Gilbertson – W
Martin Gluch – W
Karen Gustashaw – W
Mike Kenig – T
and
January 10 – 11, 2006
Phoenix, Arizona
Represented by:
Fred Behlen – T, W
Nicholas Brown – W
Harry Solomon – T, W
Dick Donker – T
Helmut Koenig – T, W
Associated with:
Alschuler Assoc. LLC
Olympus America
GE Healthcare
Mayo Clinic
Beth Israel Deaconess Medical Center
TBD
Dictaphone
Societe Francaise de Radiologie
Hospital Europeen Georges Pompidou
DMetrix, Inc.
Kaiser Permanente
Segami Corp
Univ. of Pittsburgh
Carl Zeiss
Olympus America
Epic Systems
83 DICOM WG-20/HL7 II SIG
January 10 – 11, 2006

Mary Kennedy – W
Jacques Klossa – W
Robert Leif – W
Andy Lowe – W
John Madden – W
Jim McCain – T
Ken McCasun – W
Galen Mulrooney – T
Takashi Okuno – W
Tony Pan – W
Cecile Pistre – T
Stan Schwartz – T
Thomas Spieker – W
Ikuo Tofukuji – W
Bob Yencha – T
Members Absent (WG 20):
American College of Radiology
Merge Technologies
Others Present
Howard Clark T, W
Presiding Officers:
T = Tuesday
CAP/SNOMED
TRIBVN
Newport Instruments
DMetrix
Duke Univ./SNOMED
U.S. Veterans Health Administration
Quest Diagnostics
U.S. Dept. of Veterans Affairs
Olympus Medical Systems
Ohio State University
Sanofi Aventis
Nikon Instruments Inc.
Soft Imaging System
Takasaki Univ. of Health & Welfare
Alschuler Assoc. LLC
W = Wednesday
Voting Representative
Kahn, Charles
Cindy Levy
NEMA
Fred Behlen, Co-Chair
Helmut Koenig, Co-Chair
1.
Preliminary Events
Members reviewed and slightly modified the agenda to accommodate a report by Dr. Koenig on the meeting of the Orders and Observations Technical Committee’s coordination meeting.
Minutes from the meeting of September 12 – 13, 2005 were approved as presented.
Helmut Koenig reported on his observations from the Orders and Observations Technical
Committee’s coordination meeting that was held during Q1 on Tuesday, January 10, 2006.
2.
CMET Ballot Preparation
Co-chair Helmut Koenig led a discussion of the most recent draft of the IISIG CMET Ballot. He noted that “A_DicomSequence minimal” CMET is used to reference DICOM composite objects within HL7 Version 3 messages. It provides a single location for identifying information of the study/series/instance hierarchical context of DICOM composite objects that are referenced for a specific purpose. Likewise, “A_DicomCompositeObjectReference minimal” CMET provides detailed information on the referenced DICOM composite objects such as images, presentation states and DICOM structured documents. Members focused their attention on the details contained in the various tables included in this ballot document. At the conclusion of this discussion, all agreed that it is ready for forwarding to the Orders & Observations Technical Committee for ballot.
84 DICOM WG-20/HL7 II SIG
January 10 – 11, 2006

During the course of these discussions, members noted that there is no DICOM code for reference frame. Fred Behlen agreed to bring this situation to the attention of WG-06 – probably in the form of a Change Proposal. At the conclusion of this discussion, members applauded Dr. Koenig’s mastery of the English language.
3.
CDA Implementation Guide
During Q1 on the first day, Co-chair Fred Behlen summarized the status of IISIG/WG-20’s effort to develop a CDA Implementation Guide (Release 2 – Levels 1 and 2) for Diagnostic Imaging
Reports. This guide is largely based on HL7’s Care Record Summary. Early in the discussion, members reviewed the dozen or so “Imaging Report Document Titles” listed in DICOM’s Part 16 and the hundreds of LOINC Codes having “Doc” as their Scale Type. Members proceeded to work through the LOINC list in an effort to identify the few specific codes that might relate to the desired
Implementation Guide. A total of 44 were selected, but this list was later abandoned based on the discussion with the Structured Documents Technical Committee. (See results in Item 4 below.)
During Q2 and Q3 of the second day, Dr. Behlen led a detailed review of a draft version of this document.
4.
Joint Meeting with Structured Documents on Radiology Reporting CDA Implementation
Guide
During the third quarter of Day 1, members hosted a joint meeting with the Structured Documents
Technical Committee. Fred Behlen, who happens to be co-chair of both groups, noted that the objective of this joint meeting is to review progress toward the development of an HL7
Implementation Guide for Radiology Reports and to discuss DICOM SR <–> CDA R2
Transformations.
Dr. Behlen began the discussion by showing the very limited number of codes that had been identified during the discussion of Item 3 above. Members of the SDTC found that this was not an appropriate list. Instead, they believe that the IISIG needs to look at the detailed list of Radiology
Report Titles that is concerned with claims attachment and found in LOINC’s “RELMA” database
#26106-5 using Scale Type = “NAR” and Class = “RAD” and Component = “VIEWS.” While all agreed that this information should be transmitted to LOINC, there was no agreement on how to accomplish it formally.
Ultimately, members of both groups thought it would be best to allow for use of a title that includes identification of the procedure, modality and the body part imaged (e.g., Chest CT). However, only one LOINC code is allowed for the title – 18748-4. Looking to the future, members may wish to consider identifying additional codes (recommended or standardized) for procedure, modality and the body part imaged.
5.
Joint Meeting with the Pathology SIG & DICOM WG-26
Co-chair Fred Belen welcomed members of the HL7 Pathology SIG and DICOM WG-26 and identified the two key issues that he thought should be considered during this joint session:

Treatment of specimens

Workflow structure
85 DICOM WG-20/HL7 II SIG
January 10 – 11, 2006

Visitors agreed that how one handles specimens and integrates the study results into reports was clearly of interest to them. Additionally, they were interested in the use of synoptic reporting in
HL7.
After participant introductions, Harry Solomon presented a brief summary of workflow for lab procedures that could apply to pathology studies. This included consideration of the types and content of messages/data passing between the various entities (e.g., order placer, order filler, imaging modality, image manager/archive, automation manager, repository, etc.).
Mr. Solomon also noted that the IISIG/WG-20 is working to develop a CDA Implementation Guide for Radiology Reports that is expected to have substantial applications for Pathology. The key issue is how one references images.
Looking to the future, representatives of the Pathology community see the need to decide between three different options for communication between the Laboratory Information System and Images.
These include DICOM, HL7 and sending DICOM elements inside an HL7 wrapper.
Three topics were identified for follow-on joint meetings – the reference model, workflow model, and CDA Implementation Guide.
6.
Interactions with the Orders & Observations TC
During Q4 on Wednesday, January 11, members participated in joint meeting with the Orders and
Observations Technical Committee. Minutes from this joint meeting are provided by O&O.
7.
New Business
Nick Brown reported on a problem with WADO that occurs when one exports an image to a server outside the domain in which the image is stored. In this case the URLs do not work because the server is different. A change is needed to include a manifest adapted from the
DICOMDIR (Table 7.1-1 in DICOM Part 10).
8.
Next Meeting
Future face-to-face meetings of WG-20/HL7-IISIG will be held on:

May 9 – 10, 2006 in San Antonio, Texas;

September 12 – 13, 2006 in Boca Raton, Florida;

January 9 – 10, 2007 in San Diego, California.
9.
ADJOURNMENT
The meeting adjourned at 5:10 P.M. on Wednesday, January 11, 2006.
Reported by:
Reviewed by Counsel:
Howard E. Clark, Secretary
January 25, 2006
January 30, 2006
86 DICOM WG-20/HL7 II SIG
January 10 – 11, 2006