Align Document Status Information with DICOM SR

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Submitted by: <<Helmut Koenig>>	Revision date: <<Revision Date>>
Submitted date: <<October 27, 2009>>	Change request ID: <<Change Request ID>>

Issue

For communication of imaging results document status information should be harmonized between CDA and DICOM SR. DICOM has introduced a new Preliminary Flag in the SR header that indicates whether the SR document is intended to be regarded as a preliminary or final report. This is independent of the existing SR concept of "completeness" (Completion Flag) that is used to indicate whether the document contains partial or complete content.

Recommendation

• Clarify whether the CDA ClinicalDocument Status Code value "Active" (refer to Medical Records, Section 1.1.4 "Document Statuses and Transitions") matches DICOM SR Preliminary Flag value "PRELIMINARY" (DICOM Definition: "PRELIMINARY - this report precedes the final report and may contain limited information; it may be time sensitive, and it is not expected to contain all the reportable findings")
• Clarify whether the CDA ClinicalDocument Status Code value "Completed" (refer to Medical Records, Section 1.1.4 "Document Statuses and Transitions") matches DICOM SR Preliminary Flag value "FINAL" (DICOM Definition: "FINAL – this report is the definitive means of communicating the results of a procedure")
• Discuss concept of "completeness" as used by DICOM SR (completeness of content) and CDA (completeness of authentication)

in order to determine whether further harmonization is required.

Rationale

The distinction between PRELIMINARY and FINAL reports is derived from the ACR Practice Guideline For Communication Of Diagnostic Imaging Findings.

Discussion

This would require that we include the document status value in the header.

We would require that the document needs to be revised when the status value changes.

We will need to consider this in the context of the SAEAF behaviorial framework.

We will need to also consider lab status management and see how this relates to the document use case.

Recommended Action Items

Helmut will develop a matrix of DICOM fields with values and within the boxes indicate what is known from CDA header values and what is unknown. Identify use cases for unknown states or boxes and bring back to discussion.

-> The document is available on the HL7 Website, Imaging Integration (Documents and Presentations) [1]. The file has been uploaded after the SD / II Conference Call on July 1, 2010.

Resolution

Feb 9, 2010 SDWG teleconference: Refer to OO. Revisit after OO decision.

June 01, 2010 SDWG teleconference: We agree that there is a requirement to better characterize the state of order fulfillment (e.g. partial, complete) (where the state of fulfillment assumes a finalized document). We'll need further work (along with OO) to figure out how best to represent this. abstain: 1; opposed: 0; in favor: 9.