Consolidated Health Informatics Initiative

Preliminary Information Sheet[1]

Domain Title and Team Lead:

Team Co-leads: Dr. William Heetderks and Dr. Richard Swaja  (NIH/NIBIB)

Scope:

The primary application of this standard is for combining data from several media (e.g., images, photos, audios, videos, faxes, etc.) into patient records.  This standard is useful throughout the federal healthcare system, which employs a wide variety of medical records and patient information systems.  In addition to considering characteristics associated with the broad scope of media used by federal healthcare facilities, the standard also considers associated interests such as security, long-term storage and retrieval, and unique identifiers.  The standard does not encompass multimedia information used for research or clinical trials.

Domain/Sub-domain	In-Scope (Y/N)
Incorporation of multimedia information into patient records:	Y
Images	Y
Audio	Y
Critical-care patient monitoring data	Y
Validated instruments	Y
Video information	Y

Alternatives Identified:

 The preliminary list of standards for review includes:

Standard	Initial comments
SNOMED CT	Deals with indexing images to patient records, yet this standard does not appear to encompass the range of multimedia information (including imaging technologies, hardware, and software related to audio, video, imaging, etc.) required for this domain.
DIG35	DIG35 is a set of metadata standards being developed by the International Imaging Industry Association. They have working groups on several potentially relevant multmedia standards.
Standard	Initial comments
DICOM	DICOM is an emerging standard for exchange of medical image information and needs to be given serious consideration.
IEEE 1073	This standard is primarily aimed at research data.  While it contains some elements that may be applicable to this evaluation, patient medical records are not the focus of the standard.

In addition we are seeking additional input from existing agencies and professional organizations:

Agency/ Organization	Initial Comments
NIST	A NIST Workshop on Biomedical Data Integration Standards was held on November 4 in Bethesda, Maryland.  The workshop primarily addressed research data and patient records, and the results will not be ready until mid-2004.
RSNA	RSNA, the Radiological Society of North America has been active in promoting the DICOM standard and currently has working groups focussed on developing several multimedia standards that have some relevance.

Initial Thoughts, Issues, and Comments for Feedback
(Content:  Preliminary thoughts from teamwork to check in with broader group of stakeholders).

• Digital Imaging and Communications in Medicine (DICOM) is gaining worldwide acceptance as the standard by which medical digital images will be exchanged. It enables images and associated diagnostic information to be retrieved and transferred from various manufacturers' devices as well as medical staff workstations. DICOM is a commercial, cooperative standard that is continually evolving. Its goals are to achieve interoperability through negotiation and cooperation and to improve workflow efficiency between imaging systems and other healthcare information systems worldwide. Most diagnostic medical imaging vendors have incorporated DICOM into their product design and are actively participating in its enhancement. Likewise, the majority of professional societies support and are involved with enhancement of the standard. DICOM incorporates several different levels of services needed to accomplish an integrated digital imaging environment.
• DIG35 is a set of metadata standards under development by the International Imaging Industry Association (I3A) to allow for the efficient archiving, indexing, cataloging, reviewing, and retrieving individual media assets from a larger database. The International Imaging Industry Association (I3A) is the largest imaging industry group worldwide. The approximately 90 member companies of this not-for-profit association are dedicated to developing and promoting the adoption of open industry standards, which should be considered as highly viable options for the purpose of this CHI workgroup, with its specific focus on Multimedia standards.
• Existing image standards upon which the DIG35 initiative is based include JPEG, MPEG-7 and XML, all of which have been adopted as convention, although the MPEG standard continues to evolve as compression algorithms and bandwidth improve.
• The Radiological Society of North America (RSNA) has several working groups related to standards development for integration and exchange of radiological data: The IHE (Integrated Healthcare Environment) is a program to advance data integration in health care. This group complements standards such as DICOM and HL7. Preliminary discussions with RSNA members and review of the web site materials suggest that this activity is in the formative stage.