Jörg Riesmeier

A survey and analysis of Electronic Healthcare Record standards

Medical information systems today store clinical information about patients in all kinds of proprietary formats. To address the resulting interoperability problems, several Electronic Healthcare Record standards that structure the clinical content for the purpose of exchange are currently under development. In this article, we present a survey of the most relevant Electronic Healthcare Record standards, examine the level of interoperability they provide, and assess their functionality in terms of content structure, access services, multimedia support, and security. We further investigate the complementarity of the standards and assess their market relevance.

Digital Imaging and Communications in Medicine

Over the past 15 years Digital Imaging and Communications in Medicine (DICOM) has established itself as the international standard for medical image communication. Most medical imaging equipment uses DICOM network and media services to export image data, thus making this standard highly relevant for medical image processing. The first section of this chapter provides a basic introduction into DICOM with its more than 3,600 pages of technical documentation, followed by a section covering selected advanced topics of special interest for medical image processing. The introductory text familiarizes the reader with the standard’s main concepts such as information objects and DICOM media and network services. The rendering pipeline for image display and the concept of DICOM conformance are also discussed. Specialized DICOM services such as advanced image display services that provide means for storing how an image was viewed (“Softcopy Presentation States”) and how multiple images should be aligned on an output device (“Structured Display” and “Hanging Protocols”) are described. We further describe DICOM’s sophisticated approach (“Structured Reporting”) for storing structured documents such as CAD information, which is then covered in more detail. Finally, the last section provides an insight into a newly developed DICOM service called “Application Hosting”, which introduces a standardized plug-in architecture for image processing, thus permitting users to utilize cross-vendor image processing plug-ins in DICOM applications.

Electronic Health Record Standards - A Brief Overview

Most medical information systems store clinical information about patients in proprietary format. To address the resulting interoperability problems, several electronic health record (EHR) standards that enable structured clinical content for the purpose of exchange are currently under development. In this article, we present a brief overview of the most relevant EHR standards, examine the level of interoperability they provide and assess their functionality in terms of content structure, access services, multimedia support and security.

DICOM Structured Reporting—a prototype implementation

Abstract About 1 year ago, Digital Imaging and Communications in Medicine (DICOM) Structured Reporting (SR) has been released as an official extension of the DICOM standard. Structured Reporting introduces a new concept for structuring and encoding medical reports in a standardised manner. Since this approach is quite different from any other extension that has been added to the DICOM standard in the past, it is not surprising that there is no “real” application available up to now. However, we have developed a DICOM SR editor and viewer, and demonstrated this prototype at RSNA infoRAD 2000 and ECR 2001 together with two of DICOMs new security extensions: secure network transmission and digital signatures.

Extending the IHE initiative to Europe: experiences

Abstract The IHE (Integrating the Healthcare Enterprise) initiative has recently developed into a multinational effort that addresses the specific needs of healthcare systems in North America, many European countries as well as Japan. The introduction of IHE in Europe is a particular challenge because the structure of the healthcare sector deviates significantly from country to country, with different legislation, language, medical and organisational procedures and hospital information systems (HIS)/RIS systems that are typically tailored towards a specific national market. Experiences in Europe show that IHE cannot simply be copied, but has to be adapted to the specificities of national healthcare systems. However, these are only of minor nature compared to the overall complexity of the transactions involved.

A unified approach for the adequate visualization of structured medical reports

DICOM Structured Reporting (SR) allows for the exchange of structured data and coded information in a standardized way. Although SR documents cannot be viewed directly, the DICOM standard does not specify how an application should render them. As a consequence, the interoperability of SR documents which are intended to be displayed to a medical user is restricted to those structures that are known to the visualizing application. In order to avoid this limitation, we have developed a unified process for the adequate visualization of arbitrary structured medical reports. The basic idea of this new approach is to map well-known sub-structures of the document tree (e. g. templates) to appropriate display components. For this purpose, the generic processing part is strictly separated from an extensible knowledge base which includes a machine-readable description of the template structures and display components. During our work we found out that the template detection is a crucial part of the whole visualization process. On the one hand, the existing template identification method in the DICOM standard covers only a limited number of cases. On the other hand, the complexity and dynamic structure of SR templates make the detection difficult or even impossible in certain cases. Therefore, we propose to enhance this identification method and to revise the corresponding part of the standard. In conclusion, we hope that the presented approach will assist vendors in developing general purpose reporting workstations and thereby promote the use of DICOM Structured Reporting.

Integration einer automatischen Archivierungskomponente für kardiologische Magnetresonanz-Aufnahmen in ein medizinisches Dokumentationssystem

Seit dem Jahr 1995 werden in der Kardiologie des Klinikums Oldenburg zur Dokumentation von Ultraschall- und Herzkatheteruntersuchungen die Software-Systeme GO-Echo und GO-Kard eingesetzt, die in enger Zusammenarbeit zwischen dem Informatik-Institut OFFIS und dem Klinikum Oldenburg entstanden sind. Dieser Beitrag beschreibt die funktionalen Anforderungen, die bei der Erweiterung der Systeme um Komponenten zur automatisierten Konvertierung und Archivierung von kardiologischen Magnetresonanz-Aufnahmen gestellt wurden, und veranschaulicht deren technische Realisierung.

Experiences with a workstation prototype for softcopy reading within the Bavarian mammography recertification programme

Abstract In January 2002, the Bavarian Statutory Health Care Administration (“Kassenarztliche Vereinigung Bayerns”, KVB) started a recertification programme for quality assurance and quality improvement in mammography reading. All accredited radiologists and gynecologists are asked to prove their qualification every 1–2 years. The recertification programme requires the physicians to read 50 cases randomly selected from a larger collection of high-quality test cases. The portion of malignant and benign cases corresponds to the requirements of the German National Association of Statutory Health Insurance Physicians (“Kassenarztliche Bundesvereinigung”, KBV). In order to read the mammograms on a softcopy device the images are digitised with a high-quality scanner and converted to DICOM Digital Mammography format. The workstation software has been implemented according to the particular requirements of this programme. To verify the applicability of digitised mammograms for recertification purposes, a comparative study with 32 trained radiologists and gynecologists has been performed. As a result, the study showed that there was no significant difference in the error rate of the reported findings between conventional film and softcopy reading. The first intermediate results of this quality initiative are promising. The introduction of a corresponding federal German recertification programme is intended.

DICOM Presentation States

Der DICOM-Standard ermoglicht es, heterogene Bildmanagement-Netzwerke (PACS) zu realisieren, in denen Modalitaten, Informationssysteme und Arbeitsplatzrechner verschiedener Hersteller zusammenspielen. Eine neue Erweiterung von DICOM erlaubt es, zusammen mit den medizinischen Bildern sogenannte “Presentation States” zu speichern und zu ubertragen — Objekte, die prazise beschreiben, wie die Bilder auf einem Monitor dargestellt werden sollen. Mogliche Anwendungen hierfur sind die genauere Dokumentation bei der filmlosen Befundung, Bildverteilung im Klinikum wie auch die Teleradiologie.