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Archive through July 22, 201122-07-11  02:12 pmDavid Clunie20
Archive through August 02, 201102-08-11  11:34 amJames Harrison20
Archive through August 11, 201111-08-11  04:00 pmNeelam Dugar20
Archive through September 13, 201113-09-11  01:50 pmDavid Clunie20
 
Message/Author
 Link to this message Neelam Dugar  posted on Tuesday, September 13, 2011 - 05:53 pm Edit Post Delete Post Print Post
Thanks David. This is excellent :-) just what customers need to prevent vendor lock in.

If you are successful tomorrow, customers need to include this in their specification & PQQ. I do believe those vendors who have a good product will not be threatened by this. It will show up those who wish to lock customers in for the wrong reasons.

Once again thank you David. We are grateful.
 Link to this message David Clunie  posted on Thursday, September 15, 2011 - 12:52 pm Edit Post Delete Post Print Post
The IHE Planning Committee rejected the proposal (other competing proposals for other stuff prevailed instead; minutes at "http://wiki.ihe.net/index.php?title=Radiology_Planning_Committee").
 Link to this message Neelam Dugar  posted on Thursday, September 15, 2011 - 02:02 pm Edit Post Delete Post Print Post
That is a shame indeed. :-( Does that mean there is no hope or is there a chance for the next round?

Thanks David for trying.
 Link to this message Neelam Dugar  posted on Friday, September 23, 2011 - 08:50 pm Edit Post Delete Post Print Post
I have updated the PACS spec with the following wordings

"29. END OF CONTRACT DATA MIGRATION AGREEMENTS— PACS supplier must support migration of all the stored image data (in DICOM part 10 file format preferably). Read-only access to data must be allowed to a qualified Migration Service Provider. Supplier must provide explicit information about format of images stored & if any proprietary compression is used. Information about how annotations & image flips etcs is recorded must be provide upfront by vendor (? Private tags ? other format). Database dumps must be permitted for migration if required.
Supplier must support both DICOM push & bulk data migration of data migration technologies. PACS supplier must support Image Archive/Image Manager Content Migration Profile of IHE when this becomes available. If PACS vendor chooses to store radiology reports & radiology requests, then they must be stored in standard CDA format. This will ensure that reports & requests can also be migrated into the new vendors PACS. (Normally it would be expected for RIS to migrate/store reports which will be populated into the new PACS.)"

Comments please.
 Link to this message Marco Crispini  posted on Monday, September 26, 2011 - 06:57 am Edit Post Delete Post Print Post
Hi Neelam,
I wonder is storing only in CDA too narrow? For example if reports are stored as DICOM SR, wouldn't this be acceptable as well? How about 'they must be available in standard CDA format' so the vendor as an obligation to convert to CDA on migration?
Also who qualifies the migration service provider? The Trust? The vendor? etc. Suggest 'an appointed Migration Service Provider'.
 Link to this message Marco Crispini  posted on Monday, September 26, 2011 - 09:22 am Edit Post Delete Post Print Post
*Commercial Interest*
Also the why would a VNA be an intermediate archive question earlier is valid - I think there's two answers.

First is procurement - getting your data out of the data centre, ie local ownership, is the key point, yet you can't commit to the vna architecture (eg for a 5 or 7 year contract) without going to ojeu. So one needs to accept the vna could be transitory, but at least the migration can start now rather than a last-minute panic.

Second is clinical usability - in order to be able to ‘switch off’ the Data Centre contract as soon as possible and start saving money, historicals must be kept clinically usable, i.e. up to date. This is achieved through standard interfacing of demographic updates, a feature not available is the data in a simple DICOM archive (or off-line).

People who want to know more please look at http://cypherit.co.uk/products/pacs-2013-transition-service/pacs-procurement-fre edom/
 Link to this message David Clunie  posted on Monday, September 26, 2011 - 06:19 pm Edit Post Delete Post Print Post
Historical images can indeed be kept up to date in a simple DICOM archive, as long as it is sent updated images (+/- deprecation of bad images via IHE IOCM). It is very undesirable in my opinion to attempt to simulate the behaviour of the PACS database by listening to demographic updates (a la IHE PIR), since there are many intra-PACS changes made by administrators that are not reflected in such updates.

As for CDA versus other report formats, I think it is probably premature to exclude anything IHE currently permits, which includes SR, CDA, PDF as well plain text (albeit the latter may be encapsulated). Note that keeping reports up to date is much more difficult than images (and not necessarily a PACS migration problem, as opposed to RIS/HIS migration).
 Link to this message Neelam Dugar  posted on Tuesday, September 27, 2011 - 08:31 am Edit Post Delete Post Print Post
David,

I didnt quite understand your post. Are you trying to make a difference between a "simple DICOM archive" and a "PACS"?

Is my understanding correct:
"Simple DICOM Archive"---is a simple image file with what was sent to it.
VNA = "Simple DICOM Archive" + "Database" (which holds demographics update/presentation state changes/annotations etc) without a viewer
PACS= "Simple DICOM Archive" + "Database" (which holds demographics update/presentation state changes/annotations etc)+Viewer

Thanks for your comments Marco,---I suppose the VNA is cheaper than PACS because it does not have viewer & so also can act as an intermediate store when moving from 1 PACS to another.

Is my simplistic understanding correct?
 Link to this message Neelam Dugar  posted on Tuesday, September 27, 2011 - 08:41 am Edit Post Delete Post Print Post
http://medical.nema.org/dicom/presents/reporting_rsna08.ppt

Regarding CDA vs DICOM SR this is worth a read. The direction is clear that CDA is the appropriate format for radiology reports. Displayable Report Profile of IHE also requires CDA. We will have discussions at Autumn Meeting from Micheal LaRocca, Dirco Van Norden, & Brian Elwood on CDA.

As we have a consistent approach for medical images--DICOM, we also need to move to a consistent approach to medical documents---let us hear what the experts have to say.
 Link to this message Paul Ganney  posted on Tuesday, September 27, 2011 - 09:16 am Edit Post Delete Post Print Post
It was my understanding that a VNA was just a simple DICOM store - the database removes the "N".

Paul=20
 Link to this message Neelam Dugar  posted on Tuesday, September 27, 2011 - 10:24 am Edit Post Delete Post Print Post
Paul, I am no expert on DICOM or VNA, but it seems that the definition of VNA is very variable depending on whom you speak to. I prefer the broader term "Vendor Neutral Architecture" of which which "archiving" is only a component.

Temporary "DICOM archive" to ease the process of data migration for Trusts is a credible option as described by Marco. However, it is important that if DICOM data is held in a temporay/permanent DICOM store (like LSP CDS) they get regular demographics updates. These demographics updates are held in a PACS or VNA database.

We know that the image files archive is fairly standard (particularly if held in DICOM Part10 file format).
It is only people who understand DICOM like David, Dave, Marco, Kevin Wilson, Sven Boule, Martin Peacock etc who can explain how we can standardise PACS/VNA database to ease of migration process :-)

Everyone, please do correct me, if I have got the wrong end of the stick here. :-)
 Link to this message Neelam Dugar  posted on Tuesday, September 27, 2011 - 12:03 pm Edit Post Delete Post Print Post
Use of DICOM SR
as per the presentation Harry Solomon:

"Planning your Electronic Reporting:
What kinds of reports do you need?
Text only
Text + image references
Structured text
Structured text + coded content
Multimedia"


"DICOM SR is used in key subspecialty areas that produce structured data in the course of image acquisition or post-processing, where:
Leveraging the DICOM infrastructure is easy and desirable
Results should be managed with other study evidence
Examples
Sonographer measurements
Computer-aided detection results
QC notes about images
Radiation dose reports
Image exchange manifests"

"CDA Case Uses
Diagnostic and therapeutic procedure reports
Encounter / discharge summaries
Referrals

Consistent format for all clinical documents"

He describes how CDA & DICOM SR could be used in synergy--however, CDA is preferred format for the narrative nature of radiology opinions as we have them.
 
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