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Standard

Fit for Pupose

Stewardship

Quality

Fits
Requirements

Implementation
Type 

Vendor Support

Canadian
Steward

SDO
Maintained

Complexity

Standard
Maturity

Training,
Support
and Tooling

IHE Cross-Enterprise Document Sharing - Imaging (XDS/XDS-I)

YesCloselyImage Added

Production
in Canada 

MediumHighImage Added

Yes

YesHigh

HighImage Added

 

High

YesAvailableImage Added

DICOM / HL7

YesPartialImage Added

Production
in Canada 

HighHighImage Added

No

Yes

MediumMediumImage Added

High

UnknownUnknownImage Added

Architectural Constraints and Considerations

Secondary Benefits

None of these standards impose significant architectural constraints

 

Recommendation

Supporting Rationale

IHE 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.

...

Standard

Fit for Purpose

Stewardship

Quality

Fits
Requirements 

Implementation
Type 

Vendor
Support 

Canadian
Steward 

SDO
Maintained 

Complexity

Standard
Maturity

Training, Support
and Tooling

Clinical Document Architecture (CDA) R2

YesCloselyImage Added

Limited in
Canada Limited

LimitedImage Added

No

Yes

HighHighImage Added

Normative

SomeAppropriateImage Added

Portable Document Format (PDF)

PartialPartialImage Added

Production
in Canada 

HighUbiquitousImage Added

No

N/A

LowLowImage Added

N/A

GoodHighImage Added

DICOM SR /  SC

PartialPartialImage Added

Production
in Canada 

HighHighImage Added

No

Yes

MediumMediumImage Added

Normative

UnknownUnknownImage Added

Raw Text

PartialLimitedImage Added

Production
in Canada Unknown

UnknownImage Added

No

No

LowLowImage Added

N/A

NoneHighImage Added

Architectural Constraints and Considerations

Secondary Benefits

Use of CDA document allows content to be rendered in all other formats.  Raw text based HL7 ORU and DICOM SR are widely used and present in DI-R systems and require support.

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.

...

Standard

Fit for Purpose

Stewardship

Quality

Fits
Requirements 

Implementation
Type 

Vendor
Support 

Canadian
Stewardship

SDO
Maintained 

Complexity

Standard
Maturity

Training, Support
and Tooling

Coarse Body Parts (SNOMED CT subset)

YesGoodImage Added

Production
in Canada 

HighHighImage Added

Yes

Localized

MediumMediumImage Added

Normative

GoodGoodImage Added

Anatomic Region (DICOM CID 4)

LimitedLimitedImage Added

International

HighHighImage Added

No

Yes

MediumMediumImage Added

Normative

UnknownUnknownImage Added

Architectural Constraints and Considerations

Secondary Benefits

Both terminology subsets referenced are published as flat lists with descriptions and codes.

Using pan-Canadian terminology subsets supports inter-jurisdictional interoperability.  SNOMED CT’s terminology model can be leveraged to support aggregation and analysis of the information captured within vaccination records.

Recommendation

Supporting Rationale

Coarse Body Parts (SNOMED CT subset)

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.

...