Informatics - Radiology Workflow

Summary

In this presentation, Mark Kohli discusses the patient-centric workflow in radiology, highlighting how informatics, HL7, and DICOM standards streamline the generation of medical images and reports. Using the example of Rex, an elephant undergoing an ultrasound, Kohli demonstrates how HL7 messages (ADT, ORM, ORU) coordinate patient data across systems, while DICOM ensures standardized image handling. The talk also covers tools like OsiriX, DCM4CHE, and Mirth Connect, providing resources for exploring these technologies. The session offers valuable insights into improving medical workflows and system interoperability for enhanced patient care.

Takeaways

• 😀 HL7 and DICOM are critical standards in radiology workflows for exchanging patient data, images, and reports.
• 😀 HL7 messages, such as ADT, ORM, and ORU, are used for communicating patient information, orders, and results between systems like EMRs, RIS, and PACS.
• 😀 DICOM is the standard for handling medical images, ensuring images are stored, transmitted, and processed in a consistent format.
• 😀 An Interface Engine acts as a middleware that routes HL7 messages between various systems in the radiology workflow.
• 😀 The radiology workflow involves several steps, from patient registration and order creation to image acquisition, reporting, and results distribution.
• 😀 DICOM modality worklist helps ultrasound machines and other imaging modalities organize and transfer patient exam data.
• 😀 HL7 ADT messages are sent from the EMR system to alert all downstream systems about patient registration, including insurance and demographic details.
• 😀 HL7 ORM messages are used to communicate imaging orders, including examination details like accession numbers and procedure descriptions.
• 😀 Metadata in DICOM images, such as patient information and study details, helps organize and manage imaging data through a hierarchical structure.
• 😀 Open-source tools like OsiriX, DCM4CHE, and Mirth Connect can be used to explore and manage DICOM data, HL7 messages, and medical imaging workflows.
• 😀 DICOM and HL7 standards are often incompatible (e.g., version 2 and version 3 of HL7), and this can create challenges in integrating different systems.
• 😀 The integration profile 'Scheduled Workflow' in IHE (Integrating the Healthcare Enterprise) is a guideline for improving the use of HL7 and DICOM standards across healthcare systems.

Q & A

What is HL7 and how is it used in healthcare?

HL7 (Health Level 7) is a messaging standard used to exchange healthcare-related information between systems. It allows for communication between disparate systems such as electronic medical records (EMRs), radiology information systems (RIS), and other healthcare systems to ensure seamless data flow. HL7 messages typically include patient demographics, medical orders, results, and other clinical data.

What is DICOM and how does it function in the radiology workflow?

DICOM (Digital Imaging and Communications in Medicine) is a standard for storing, transmitting, and sharing medical images. It specifies how images are represented and exchanged between devices such as ultrasound machines, PACS (Picture Archiving and Communication Systems), and radiology information systems. DICOM also includes protocols for network operations, ensuring images and related data are shared in a standardized manner.

What role does the interface engine play in the healthcare workflow?

The interface engine acts as a central router that facilitates the exchange of messages between different healthcare systems. It ensures that messages, such as HL7 orders or results, are routed to the appropriate systems (e.g., EMR, RIS, PACS). It ensures data flows smoothly without requiring manual intervention and is crucial for maintaining system interoperability.

What is an HL7 ADT message and what information does it contain?

An HL7 ADT (Admission, Discharge, and Transfer) message is used to communicate patient registration details across healthcare systems. It typically contains patient identification data, such as the medical record number, name, date of birth, contact information, insurance details, and visit information. It ensures that all downstream systems are updated with the patient's current status.

How does DICOM Modality Worklist help radiology departments?

DICOM Modality Worklist is a feature that allows medical imaging machines (like ultrasound devices) to query the PACS for patient and examination details. It helps streamline the workflow by automatically populating the imaging machine with patient data, reducing the need for manual data entry and minimizing errors during the imaging process.

What is the difference between HL7 version 2 and version 3?

HL7 version 2 uses a simple, text-based messaging format where fields are separated by pipes and carrots. It is widely adopted but less human-readable. HL7 version 3, on the other hand, uses XML (Extensible Markup Language) to structure messages, making them more readable but also more complex and less compatible with older systems. Version 2 remains more common in clinical environments today.

What are the benefits of using OsiriX in a radiology department?

OsiriX is a free DICOM viewer for Mac that allows users to view, edit, and analyze DICOM images and metadata. It is useful for radiologists and technologists who need to interact with medical images outside of the standard PACS environment. It also provides tools for self-discovery and exploration of DICOM data, which can help in research and educational contexts.

What is the purpose of a voice recognition system in the radiology workflow?

A voice recognition system in radiology allows radiologists to dictate their findings and generate reports quickly and accurately. These systems convert speech to text, reducing the need for manual transcription and speeding up the reporting process. The generated reports are then processed and sent to other systems, such as RIS, EMR, and PACS.

How does a PACS system contribute to the patient workflow?

The PACS (Picture Archiving and Communication System) is responsible for storing, retrieving, and displaying medical images. In the radiology workflow, once images are captured (e.g., from an ultrasound), they are transferred to PACS for storage. PACS allows radiologists and other healthcare providers to access images remotely, facilitating efficient diagnosis and treatment planning.

What is the significance of metadata in DICOM images?

Metadata in DICOM images refers to the data embedded within the image file that provides essential information about the image and its associated study. This includes patient demographics, examination details, imaging modality, time of acquisition, and more. The metadata helps organize the images into a structured hierarchy, ensuring that they are linked to the correct patient and study within PACS.