Standards Selection Guide for Foreign Exam Management
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A Standards Selection Guide is a summary report of the recommended standards, resources, implementation guides created to satisfy a specific set of clinical requirement at a moment in time, following the discovery process presented in the Guidance section. |
Purpose
This guide provides an overview of available standards and a recommended approach to support the Foreign Exam Management requirements as identified below. The intent is to simplify standards selection decisions in future projects and, in turn, to promote standardization of solutions across projects by providing useful information to support decision making in a readily consumable format.
Content in this guide was summarized from the Canadian XDS Affinity Domain Implementation Guide v1.1 20140527 to provide an accessible overview of the standards selected to support the listed Use Cases.
Business Context
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Covered Use Cases
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Evaluated Standards & Recommended Approach
The following standards and related specifications were identified as candidates to support the in-scope requirements. Recommended standards are identified with summary of the rationale.
Areas of Standardization
Standardization Requirement | Options | Choice | Rationale |
Document and Image Sharing | IHE Cross-Enterprise Document Sharing - Imaging (XDS/XDS-I) | X | The IHE XDS-I.b profile specifies the use of existing standards including HL7 and DICOM to enable registration and sharing of images and reports. A Canadian XDS Affinity domain guide is available to support implementation of the profile. |
DICOM / HL7 |
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TBD |
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Report Format | Clinical Document Architecture (CDA) R2 | X | It is the goal of the Canadian XDS Affinity domain that reports will be stored in HL7 CDA format (using the pan-Canadian header format) as these reports (a) support required metadata, and (b) can be transformed to all other formats.
* Raw text based HL7 ORU and DICOM SR are widely used and present in DI-R systems. |
Portable Document Format (PDF) |
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DICOM SR / SC | * | ||
Raw Text | * | ||
Anatomic Region Code | Coarse Body Parts (SNOMED CT subset) | X | The DICOM CID 4 value set is very detailed and generally inconsistent with the general approach of “casting a wide net” employed when fetching content within the FEM use cases. |
Anatomic Region (DICOM CID 4) |
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Document and Image Sharing
Foreign Exam Management will be implemented by an organization participating a jurisdictions’ shared Diagnostic Imaging Repository (DI-R) system. The DI-R will provide for registration and long term storage of sets of images and reports and standards based services that will be leveraged and, possibly, upgraded to support the FEM use case(s).
Standard | Maturity | Sustainability | Implementation | ||||
Standards Process | Implementation | Canadian Implementation | Superseded? | Vendor Support | Complexity | Training, Support and Tooling Availability | |
IHE Cross-Enterprise Document Sharing - Imaging (XDS/XDS-I) | Final | Production | Production | No | High | High | Good |
DICOM / HL7 | Final | Production | Production | No | High | High | Good |
Architectural Constraints and Considerations | Secondary Benefits | ||||||
None of these standards impose significant architectural constraints |
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Recommendation | Supporting Rationale | ||||||
HE Cross-Enterprise Document Sharing - Imaging (XDS/XDS-I) | The IHE XDS-I.b profile specifies the use of existing standards including HL7 and DICOM to enable registration and sharing of images and reports. A Canadian XDS Affinity domain guide is available to support implementation of the profile. |
Report Format
XDS/XDS-I supports a range of report formats through the use of different transaction and reporting
Standard | Maturity | Sustainability | Implementation | ||||
Standards Process | Implementation | Canadian Implementation | Superseded? | Vendor Support? | Complexity | Training, Support and Tooling Availability | |
Clinical Document Architecture (CDA) R2 | Final | Production | Production | No | High | High | Good |
Portable Document Format (PDF) | Final | Production | Production | No | High | Medium | Good |
DICOM SR / SC | Final | Production | Unknown | No | High | ? | Good |
Raw Text | Final | Production | Unknown | No | High | Low | Good |
Architectural Constraints and Considerations | Secondary Benefits | ||||||
None of these standards impose significant architectural constraints | PDF may preclude secondary use, while the structured data of a CDA document supports machine readability and may enable secondary use of clinical data, clinical decision support or application of administrative/demographic data to analytics/business intelligence | ||||||
Recommendation | Supporting Rationale | ||||||
Clinical Document Architecture (CDA) R2 | It is the goal of the Canadian XDS Affinity domain that reports will be stored in HL7 CDA format (using the pan-Canadian header format) as these reports (a) support required metadata, and (b) can be transformed to all other formats. |
Anatomic Region Code
Metadata plays an important role in the identification of relevant priors during the fetch and pre-fetch use cases. The significant coded metadata elements for the FEM use case are the acquisition modality of image and the anatomical region being studied. Acquisition modality was adopted as prescribed. This section identifies options considered to identify the Anatomic Region.
Standard | Maturity | Sustainability | Implementation | ||||
Standards Process | Implementation | Canadian Implementation | Superseded? | Vendor Support? | Complexity | Training, Support and Tooling Availability | |
Coarse Body Parts (SNOMED CT subset) | Final | Production | Production | No | High | High | Good |
Anatomic Region (DICOM CID 4) | Final | Production | Production | No | High | Medium | Good |
Architectural Constraints and Considerations | Secondary Benefits | ||||||
None of these standards impose significant architectural constraints | Use of SNOMED CT to encode the Canadian code set may help enable mapping from the DI Procedure Codes to the Coarse Body parts and/or definition of automated validation. | ||||||
Recommendation | Supporting Rationale | ||||||
Clinical Document Architecture (CDA) R2 | The DICOM CID 4 value set is very detailed and generally inconsistent with the general approach of “casting a wide net” employed when fetching content within the FEM use cases. |
Implementation Resources
Existing Implementations
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