Bbs:V1 IG

Dit is een tijdelijke pagina met wijzigingen voor issue BBS-35. De gepubliceerde versie vind je hier.

Implementation Guide: Image Availability (Beeldbeschikbaarheid)

!! This FHIR IG is currently under development and cannot be considered stable and ready for use. For questions and change requests regarding this IG, please create a ticket in BITS <link to bits https://bits.nictiz.nl/projects/BBS/issues/BBS-3?filter=allopenissues>. <like: https://informatiestandaarden.nictiz.nl/wiki/cio:V2.0.0_FHIR_CiO ) !!

Contents

[ 1. Introduction 3]

[ 2. Actors involved 5]

[ 3. Boundaries and relationships 6]

[ 3.1. Beelden information standard MedMij 7]

[ 3.2. NIHEMDS 7]

[ 4. Use case 1: Raadplegen Tijdlijn Data / Retrieve timeline data 7]

[ 4.1. Introduction 8]

[ 4.2. Actors 8]

[ 4.3. Required mappings 8]

[ 4.4. Invocations 9]

[ 5. Use case 2: Raadplegen Beelden / Retrieve images 9]

[ 5.1. Introduction 10]

[ 5.2. Actors 10]

[ 5.3. Required mappings 10]

[ 5.4. Invocations 11]

[ 6. Use case 3: Raadplegen Verslagen / Retrieve report 11]

[ 6.1. Introduction 12]

[ 6.2. Actors 12]

[ 6.3. Required mappings 12]

[ 6.4. Invocations 13]

[ 7. Use case 4: Sturen Beelden / Send images 14]

[ 7.1. Introduction 15]

[ 7.2. Actors 15]

[ 7.3. Invocations 16]

[ 7.3.1. Request message 16]

[ 7.3.2. Response message 16]

[ 8. Use case 5: Sturen Verslagen / Send report 16]

[ 8.1. Introduction 17]

[ 8.2. Actors 17]

[ 8.3. Invocations 18]

[ 8.3.1. Request message 18]

[ 8.3.2. Response message 18]

[ 9. Profiles 18]

[ 9.1. Zib 19]

[ 9.2. IHE 19]

 

Inspiration:

https://informatiestandaarden.nictiz.nl/wiki/MedMij:V6/FHIR_Patient_Corrections

https://informatiestandaarden.nictiz.nl/wiki/MedMij:V6/FHIR_Vaccination-Immunization

https://informatiestandaarden.nictiz.nl/wiki/MedMij:V2020.01/FHIR_IG

https://informatiestandaarden.nictiz.nl/wiki/MedMij:V2019.01_FHIR_MedicationProcess#Use_case:_retrieve_medication_information

https://informatiestandaarden.nictiz.nl/wiki/MedMij:V2020.01/FHIR_PDFA

https://informatiestandaarden.nictiz.nl/wiki/Gebz:V1.2_FHIR_IG#Collect_client-related_data_from_health_care_providers_.28MedMij_0.1_integrale_zwangerschapskaart.29

Introduction

1.1 Background

In 2018 the Dutch Association for Radiologists (NVVR) and the Dutch Association for Health Providers (VZVZ) released the document “Landelijke beschikbaarheid radiologische beelden voor zorgverlener en patient: functionele vereisten” <link: > https://radiologen.nl/system/files/bestanden/documenten/functionele-eisen-radiologische-beelden-v1.0.pdf>. This document describes that the current radiology situation in the Netherlands is not acceptable. In 2016, for almost 1 out of 4 radiology patients, there is the potential need to exchange images and reports across multiple health providers and/or referrers. The current situation is that there are short term solutions in place, but these are not satisfying; it asks a lot of effort to get the correct images (and/or reports) from one place to another. This has another unwanted effect: each health provider has a part of the patient’s dossier – not only unwanted, but also a risk for continuity, safety and results related to the patient. The released document explains that the vision is that every radiologist should be able to view a timeline of every radiology related research concerning the patient.

The main objectives of the mentioned collaborative document are:

1. Within 3 years a timeline with all radiology related studies of a patient, including referrals.
2. This timeline is available in the work environment of every radiologist regardless of where the radiologist is working at that time.
3. By using 1 timeline where all research and referrals are included, this will provide the treating radiologist with the much-needed insight and overview regarding one patient.

1.2 About this document

This document describes the Dutch usage of the IHE profiles based on XCA, as provided in volumes 1 through 3 of the IHE IT Infrastructure Technical Framework <link: https://profiles.ihe.net/ITI/TF/index.html. We have derived a technical advice how healthcare providers can provide radiology images and/or reports and will provide a set of guidelines and technical requirements.

For the “Image Availability”, we assume that the reader is familiar with the mentioned IHE IT Infrastructure Domains.

Furthermore, this document is regarding the Alpha release. It is very likely that there will be features added, adjusted and/or removed in future releases.

This document is not an introduction to XCA and/or XDS and it is assumed that the reader is familiar with this technical framework. This document will only focus on requirements from the IHE profiles, combined with the metadata set for BBS, which are relevant for national use in the Netherlands.

This implementation guide also only focusses on achieving cross gateway interoperability between actors in the Netherlands

'1.3 Scope for Alpha release

• Applicable only for Radiology.
• Use cases 1 – 3 as mentioned in the FO <link: https://informatiestandaarden.nictiz.nl/wiki/Bbs:V0.3.0_Concept_Ontwerp_Beeldbeschikbaarheid>.
• XCA only (XDS will not be explained in this document).
• National cross gateway interoperability

As we use a unique identifier (BSN) for identification within the Netherlands (which is mandatory by law), we use this for the alpha release to uniquely identify our patients. Therefore, use cases only include national citizens and foreigners are not in scope for the alpha release.

1.4 Glossary

We use the IHE definiton of “documents”; these documents can exist out (dicom) studies, images and/or reports.

Die documents kunnen vervolgens weer (dicom)studies, images en/of reports bevatten

Document

Study / Images

Reports

 

1. 'Actors involved 

Table 1 shows the relevant XCA-I actors and transactions in perspective of the systems used.

Persons		Systems name	XCA-I
Name	Description	Name	Actors	Transactions
Radiologist	This actor is responsible for generating and transmitting medical images and making them available to the responding gateway. In this role, the radiologist (and/or health organisation he/she works for) is the Document Source ie they are responsible for the metadata added to the document(s).	PACS	Responding Gateway	ITI-38 Cross Gateway Query
				ITI-39 Cross Gateway Retrieve
			Responding Imaging Gateway	RAD-75 Cross Gateway Retrieve Imaging Document Set
Radiologist/ Treating physician	This actor is a healthcare provider that request access to images and related information from image-generating healthcare providers.	PACS/EPD	Initiating Gateway	ITI-38 Cross Gateway Query
				ITI-39 Cross Gateway Retrieve
			Initiating Imaging Gateway	RAD-75 Cross Gateway Retrieve Imaging Document Set

1. 'Boundaries and relationships 

The Image Availability specification applies to the exchange of images and related information between healthcare providers in the Netherlands. It does not specify how images are generated or stored, but rather how they are made available to other healthcare providers. So, healthcare providers are responsible for their own infrastructure. Only the cross-community access via synchronous XCA-I is in scope, for this version of the information standard. The following versions will address the non-XCA/XDS exchange.

1. Beelden information standard MedMij

Images (Beelden) <insert link to Images: https://informatiestandaarden.nictiz.nl/wiki/MedMij:V2020.01> is a Dutch national initiative for the exchange of medical images between patient to healthcare organizations. The Image Availability and the Images standard both aim to improve the exchange of medical images. However, Images is a specific implementation of medical image exchange from patient to healthcare provider, while Image Availability provides a framework that can be used between healthcare providers. They are therefore two different standards that should not be confused with each other during implementation.

1. NIHEMDS

The NIHEMDS is the National IHE MetaData Set (Dutch: Nationale IHE MetaData Set). This might be helpful for implementing the Image Availability information standard. The NIHEMDS is published on ART-DECOR, see here: <2013-12-04T12:24:19 and make this link work>.

1. 'Use case 1: Raadplegen Tijdlijn Data / Retrieve timeline data
   1. Introduction

The Retrieve Timeline Data use case enables a requesting gateway to retrieve a timeline of imaging studies for a specific patient. This use case is implemented using the ITI-38 Cross Gateway Query transaction, which allows the requesting gateway to query for a list of documents based on patient identifiers and other search criteria. The responding gateway returns a set of documents that match the query criteria, which can then be used to construct a timeline of imaging studies for the patient.

ITI-38 is the Cross Gateway Query with essentially the same semantics as the ITI-18 (Registry Stored Query). By using ITI-38, the initiating Gateway sends out a query request, responding gateways send back their query response.

A timeline in this use case is an ordered sequence of items belonging to a single patient (as stated in paragraph 1.3 we use BSN in the Netherlands) where the items in the timeline represent documents stored in the registry that match the query keys used to create it. In IHE terms these documents are defined by XDSDocumentEntries in the registry. Creating a timeline for a given patient (with a known BSN beforehand) is best done in two steps by using the ITI-38 query as follows:

Step 1:

Find the list of documents that belong to the patient by issuing an ITI-38 with

1. QueryID = “FindDocuments”
2. returnType = “ObjectRef”
3. a simple set of query keys (maybe a date range or clinic type)

This should return a list of matching document UUIDS (unique registry identifiers). As we don’t know the number of documents belonging to the patient (number of matching query responses) beforehand this approach provides the “smallest” response in terms of data per document. However, this is not enough detail to create a timeline entry.

Step 2:

Using the list of returned document UUIDS from step 1, perform a second query for each document by issuing an new ITI-38:

1. QueryID = “GetDocument”
2. returnType = “LeafClass”
3. query key = document UUID.

This will return the registered DocumentEntry details, including all known metadata for the document. This can be used to populate the timeline entry representing the document.

1. The use of two ITI-38 query types to create this timeline is also recommended in the IHE framework – see ITI Vol2: 3.18.4.1.2.3.1 Parameter returnType.Actors

Actors		Systems Name	XCA-I
Name	Description		Gateway	Transactions
Radiologist	This actor is responsible for generating and transmitting medical images and making them available to the responding gateway. In this role, the radiologist (and/or health organisation he/she works for) is the Document Source ie they are responsible for the metadata added to the document(s).	PACS	Responding Gateway	ITI-38 Cross Gateway Query
Radiologist/ Treating physician	This actor is a healthcare provider that requests access to images and related information from image-generating healthcare providers.	PACS/EPD	Initiating Gateway	ITI-38 Cross Gateway Query

1. Required Metadata

As stated above, our advice is to use the ITI-38 transaction for a Cross Gateway Query. However, to be able to query these studies (and get appropriate responses), the uploader of these studies (ie the Document source) is required to add metadata to these studies.

Based on the National IHE Metadata Set, we have derived specific metadata which is obligated for all documents within the scope of project Image Availability. We have listed only the required metadata below; for the content within the required element use ART-DECOR 2022-06-13T00:00:00.

''''Element	IHE Parameter
Patient.Naamgegevens.Geslachtsnaam.Achternaam	sourcePatientInfo
Patient.Indentificatienummer	XDSDocumentEntry.patientId
Patient.Geboortedatum	sourcePatientInfo
Patient.Geslacht
Onderzoek.Verrichting.Locatie.Zorgaanbieder.AfdelingsSpecialisme	XDSDocumentEntry.practiceSettingCode

1. Invocations

Sample messages have been generated as guides for developing the standard. For the sample messages, see GitHub <link: https://github.com/Nictiz/Nictiz-XCA-Images>.

1. 'Use case 2: Raadplegen Beelden / Retrieve images
   1. Introduction

Use case 1 enables a requesting gateway to retrieve a timeline of imaging studies for a specific patient. Use case 2 is used when the radiologist / attending physician consults relevant images in order to arrive at a better and more complete assessment, report and advice than would be the case without it.

Use case 2 elaborates on usecase1: after using ITI-38 and ITI-39 to query and retrieve a timeline of imaging studies for the patient, transaction RAD-75 can be used to retrieve (an) imaging document set(s).

1. Actors

Persons		Systems name	XCA-I
Name	Description		Actors	Transactions
Radiologist	This actor is responsible for generating and transmit medical images and making it available to the responding gateway. In this role, the radiologist (and/or health organisation he/she works for) is the Document Source ie they are responsible for the metadata added to the document(s).	PACS	Responding Gateway	ITI-38 Cross Gateway Query
				ITI-39 Cross Gateway Retrieve
			Responding Imaging Gateway	RAD-75 Cross Gateway Retrieve Imaging Document Set
Radiologist/ Treating physician	This actor is a healthcare provider that request access to images and related information from image-generating healthcare providers.	PACS/EPD	Initiating Gateway	ITI-38 Cross Gateway Query
				ITI-39 Cross Gateway Retrieve
			Initiating Imaging Gateway	RAD-75 Cross Gateway Retrieve Imaging Document Set

1. Required mappings

There are several required parameters. See table X. For the content within the required element, use ART-DECOR: 2022-06-13T00:00:00.

Element	IHE Parameter
Onderzoek.Verrichting.VerrichtingsType	$XDSDocumentEntryClassCode

1. Invocations

Sample messages have been generated as guides for developing the standard. For the sample messages, see GitHub <link: https://github.com/Nictiz/Nictiz-XCA-Images>.

1. 'Use case 3: Raadplegen Verslagen / Retrieve report
   1. Introduction

The Retrieve Report use case enables a requesting gateway to retrieve an imaging study report for a specific patient. This use case is implemented using the ITI-38 Cross Gateway Query transaction, which allows the requesting gateway to query for a set of imaging study reports based on patient identifiers and other search criteria. The responding gateway returns the requested report using the ITI-39 Cross Gateway Retrieve transaction, which provides access to the report and enables its transfer to the requesting gateway.

1. Actors

The actors for this use case are the requesting gateway, which initiates a request for an imaging study report using the ITI-38 Cross Gateway Query transaction, and the responding gateway, which provides access to and returns the requested report using the ITI-39 Cross Gateway Retrieve transaction.

Persons		Systems name	XCA-I
Name	Description		Actors	Transactions
Radiologist	This actor is responsible for generating and transmit medical images and making it available to the responding gateway. In this role, the radiologist (and/or health organisation he/she works for) is the Document Source ie they are responsible for the metadata added to the document(s).	PACS	Responding Gateway	ITI-38 Cross Gateway Query
				ITI-39 Cross Gateway Retrieve
Radiologist/ Treating physician	This actor is a healthcare provider that request access to images and related information from image-generating healthcare providers.	PACS/EPD	Initiating Gateway	ITI-38 Cross Gateway Query
				ITI-39 Cross Gateway Retrieve

1. Required mappings

There are several required parameters. See table X. For the content within the required element, use ART-DECOR: 2022-06-14T00:00:00.

Element	IHE Parameter
Patient.Naamgegevens.Geslachtsnaam.Achternaam	sourcePatientInfo
Patient.Indentificatienummer	$XDSDocumentEntryPatientId
Patient.Geboortedatum	sourcePatientInfo
Onderzoek.Verslaginformatie.AuthoriserendRadioloog.Zorgvelener.Naamgegevens.Geslachtsnaam.Achternaam	$XDSDocumentEntryAuthorPerson
Onderzoek.Verslaginformatie.DicterendRadioloog.Zorgvelener.Naamgegevens.Geslachtsnaam.Achternaam
Onderzoek.Verslaginformatie.VerslagIdentificatienummer	$XDSDocumentEntry UniqueId
Onderzoek.Verslaginformatie.DatumTijd	$XDSDocumentEntryCreationTimeFrom / $XDSDocumentEntryCreationTimeTo
Onderzoek.Verslaginformatie.StatusVerslag	$XDSDocumentEntryStatus
Onderzoek.Verslaginformatie.Verslag	$XDSDocumentEntryType

1. Invocations

Sample messages have been generated as guides for developing the standard. For the sample messages, see GitHub <link: https://github.com/Nictiz/Nictiz-XCA-Images>.

1. 'Use case 4: Sturen Beelden / Send images

!! De Use case moet nog ontwikkeld worden !! < like: https://informatiestandaarden.nictiz.nl/wiki/Gebz:V1.2_FHIR_IG#Use_case:_Neonatology >

1. Introduction

The Send Images use case enables an imaging source to send an imaging study to a receiving gateway for retrieval. This use case is implemented using the RAD-75 Cross Gateway Retrieve Imaging Document Set transaction, which allows the receiving gateway to receive the imaging study in a standardized format that can be accessed and retrieved by other gateways. The imaging source generates the imaging study and makes it available, while the receiving gateway receives the imaging study for future use.

1. Actors

The actors for this use case are the imaging source, which generates the imaging study and makes it available, and the receiving gateway, which receives the imaging study using the RAD-75 Cross Gateway Retrieve Imaging Document Set transaction.

Persons		Systems name	XCA-I
Name	Description		Actors	Transactions
Radiologist	This actor is responsible for generating and transmit medical images and making it available to the responding gateway. In this role, the radiologist (and/or health organisation he/she works for) is the Document Source ie they are responsible for the metadata added to the document(s).	PACS	Responding Gateway	ITI-38 Cross Gateway Query
				ITI-39 Cross Gateway Retrieve
			Responding Imaging Gateway	RAD-75 Cross Gateway Retrieve Imaging Document Set
Radiologist/ Treating physician	This actor is a healthcare provider that request access to images and related information from image-generating healthcare providers.	PACS/EPD	Initiating Gateway	ITI-38 Cross Gateway Query
				ITI-39 Cross Gateway Retrieve
			Initiating Imaging Gateway	RAD-75 Cross Gateway Retrieve Imaging Document Set

1. Invocations

1. 'Use case 5: Sturen Verslagen / Send report

!! De Use case moet nog ontwikkeld worden !! < like: https://informatiestandaarden.nictiz.nl/wiki/Gebz:V1.2_FHIR_IG#Use_case:_Neonatology >

1. Introduction

The Send Report use case enables an imaging source to send an imaging study report to a receiving gateway for retrieval. This use case is implemented using the ITI-39 Cross Gateway Retrieve transaction, which allows the receiving gateway to receive the report in a standardized format that can be accessed and retrieved by other gateways. The imaging source generates the imaging study report and makes it available, while the receiving gateway receives the report for future use.

1. Actors

The actors for this use case are the imaging source, which generates the imaging study report and makes it available, and the receiving gateway, which receives the report using the ITI-39 Cross Gateway Retrieve transaction.

Persons		Systems name	XCA-I
Name	Description		Actors	Transactions
Radiologist	This actor is responsible for generating and transmit medical images and making it available to the responding gateway.	PACS	Responding Gateway	ITI-38 Cross Gateway Query
				ITI-39 Cross Gateway Retrieve
Radiologist/ Treating physician	This actor is a healthcare provider that request access to images and related information from image-generating healthcare providers.	PACS/EPD	Initiating Gateway	ITI-38 Cross Gateway Query
				ITI-39 Cross Gateway Retrieve

1. Invocations

1. 'Profiles 

The Image Availability specification defines ZIB and IHE profiles.

1. Zib

Zib NL (2020)	Link to Zib NL (2020)	HCIM EN
Patient	https://zibs.nl/wiki/Patient-v3.2(2020NL)	Patient
Verrichting	https://zibs.nl/wiki/Verrichting-v5.2(2020NL)	Procedure
Zorgverlener	https://zibs.nl/wiki/Zorgverlener-v3.5(2020NL)	HealthProfessional
Zorgaanbieder	https://zibs.nl/wiki/Zorgaanbieder-v3.4(2020NL)	HealthcareProvider

1. IHE

IHE Profile	IHE Profile	Description
ITI-38 Cross Gateway Query	https://profiles.ihe.net/ITI/TF/Volume2/ITI-38.html	This profile defines a way for a source gateway to send a query request to a destination gateway to retrieve metadata about patients and their health records. The query can be based on a variety of parameters such as patient name, ID, birthdate, and diagnosis.
ITI-39 Cross Gateway Retrieve	https://profiles.ihe.net/ITI/TF/Volume2/ITI-39.html	This profile defines a way for a source gateway to request the retrieval of a patient's health record from a destination gateway. The source gateway sends a query request using ITI-38, and then uses the retrieved metadata to retrieve the patient's health record from the destination gateway.
RAD-75 Cross Gateway Retrieve Imaging Document Set		This profile allows a source gateway to request the retrieval of a patient's imaging documents from a destination gateway. The source gateway sends a query request using ITI-38 to retrieve metadata about the patient and their imaging studies, and then uses RAD-75 to retrieve the actual imaging documents from the destination gateway.