1. International Journal of Information Technology & Management Information System (IJITMIS),
ISSN 0976 – 6405(Print), ISSN 0976 – 6413(Online) Volume 4, Issue 2, May - August (2013), © IAEME
56
GENERATION OF CDA/XML SCHEMA FROM DICOM IMAGES
USING HL7 STANDARD
Dr. Kulvinder Singh Mann Er. Gursimrat kaur
Associate professor Student (Mtech -IT)
GNDEC, Ludhiana GNDEC, Ludhiana
ABSTRACT
In earlier times the communication between doctor and patient used to be complex
task, giving a right treatment to patient was time consuming as doctors could not get details
of patient case until and unless full diagnosis was done. EHR came as solution to resolve
these problems by enabling the clinicians to store data in electronic form making it globally
accessible and easily shareable among different organizations. The main objective of this
paper is to produce a set of specifications that allows free communication and exchange of
data between medical software applications in order to eliminate or reduce incompatibility
among different applications and to convert the standard patient data to XML/HL7 messaging
using CDA for interoperability of HIS.
Communication among different EHR’s is carried out by HL7 standard, who aims to
provide interoperability among different systems.
Keywords: HL7, EHR, HIS, CDA
1. INTRODUCTION
Responsibility of electronically recording patient health information lies in hands of
EHR which is interoperable in different health care settings. Following areas are focused-
demographics, progress, note, medicines, vital sign, past medical history, lab data and radio
reports. So it rules out monitoring of paper storage and possibility of medical errors.
Introducing EHR in hospitals improved the communication issues and resulted in long life
storage of patients data for better and effective diagnosis and treatment.
In a hospital there are different software applications running, developed by various
companies, so there arises a need of uniform standard for providing communication between
them. An hl7 standard comes as a solution to this problem. Hl7 standard is used to exchange
data between these different applications running at different platforms. Use of HL7 standard
proves to be beneficiary as it enables the user to access and process any required information
independently at any time.
INTERNATIONAL JOURNAL OF INFORMATION TECHNOLOGY &
MANAGEMENT INFORMATION SYSTEM (IJITMIS)
ISSN 0976 – 6405(Print)
ISSN 0976 – 6413(Online)
Volume 4, Issue 2, May - August (2013), pp. 56-59
© IAEME: http://www.iaeme.com/IJITMIS.asp
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2. International Journal of Information Technology & Management Information System (IJITMIS),
ISSN 0976 – 6405(Print), ISSN 0976 – 6413(Online) Volume 4, Issue 2, May - August (2013), © IAEME
57
1.1 HL7 STANDARD
A standard and framework with worldwide acceptance known for its capabilities like
exchange, integration, sharing and retrieval of electronic health information constitute HL7
standards.
It is based on the data obtained from medical and clinical sites and is approved by
ANSI. HL7 Standard aims to provide interoperability that improve patient care, reduce
ambiguity, optimize workflow and to enhance knowledge among various stake holders,
healthcare providers and various government agencies.
1.2 STANDARDS OF HL7
1.2.1 PACS
Picture Archiving and Communication system is an integrated computer system that
provide storage and retrieval of digital images and eliminates the need to manually store,
retrieve or transfer those images. PACS is mainly used in large number of hospitals in their
radiology department. In medical arena PACS is known to handle different images from
different modalities like CT, X-ray, tomography, X-ray etc. Its main purpose is to replace
hard film copies with digital images that can be used and seen by several different medical
professionals and different medical automation systems simultaneously. The standard format
for PACS is DICOM, accepting any image that is in DICOM format. Before PACS, the
systems did not have any standardized image format due to which image retrieval and
matching was difficult task and vendors could not share information among others to enhance
their knowledge and for better diagnosis.
1.2.2 Imaging Standards / DICOM
Universal standard for Medical Images is formed by DICOM. whether its MRI, X ray,
CT or Ultrasound all support DICOM format. A study is conducted with help of multiple
images obtained from multiple devices, such a study contains sets of pre and post contrast CT
scan images.
Each acquisition is named series, which further consists of slices, which is a DICOM
information object. Thereafter user learns about patient, the date of study from the folder
created and finally is restored to a proper place. For every information object, IOD tells
contained information and mode of storage.
1.3 HOSPITAL INFORMATION SYSTEM (HIS)
For managing administration, financial and clinical aspects , a comprehensive system
is formulated for integrating information. It targets on providing best patient care and
administration assistance through electronic data. For the sake of better and efficient decision
making, clinical and administration information is completed into single system. Thus HIS
simplifies workflow, managing daily task and overall administration becomes efficient. To
prevent any confusion each patient has unique id. The software keeps the record of medicine
purchased, medical equipments and infrastructure. The system is known for its flexibility and
multiple capabilities. Thus smoother management and administration function is possible
using such software.
1.4 HL7- CDA
HL7 popular for creating health care messaging standards also has huge contribution
in representing clinical document , it got ANSI approval in November 2008. It is a standard
for giving specification regarding structure and semantics of clinical documents. It addresses

3. International Journal of Information Technology & Management Information System (IJITMIS),
ISSN 0976 – 6405(Print), ISSN 0976 – 6413(Online) Volume 4, Issue 2, May - August (2013), © IAEME
58
common and large narrative clinical notes. Being a part of HL7 version 3 family it gets its
semantic content from HL7 reference Information Model. CDA is derived from the HL7
Reference Information Model (RIM). Targets of CDA are providing standards for exchange,
management, delivery and evaluation of health care services. So it proves to be of great help
for people unfamiliar with HL7 version 3.It provided a big breakthrough in clinical field by
providing standardization of clinical notes covering history, physical, discharge summaries
and progress notes. Deeper layer of architecture would be discovered in near future. Reasons
for its success include the flexibility of the standard and its ability to encompass all clinical
documents.
2. MATERIAL AND METHODOLOGY
The development of PACS (Picture Archiving and Communication Systems): PACS
network is constructed which consists of a central PACS server that provides storage for
database containing the images and is capapble of storing images from various
modalities(CT, X-Ray , MRI, Ultrasounds etc) in DICOM format and multiple clients have
access to those centrally stored images. They can retrieve and display these images on
medical imaging software named as DICOM viewer or these images are converted into other
image formats like Jpeg, png eliminating the need of using an additional software that is
DICOM viewer and acts as GUI. The server and the clients communicate by using the
DICOM protocol.
To interface two different formats HL7 and DICOM, HL7 CDA is used. It focuses on
content of clinical documents, which are persistent and human readable. CDA is XML based
standard and make use of this markup language for providing clinical documents.HL7 CDA
does not define how EHR’s communicate with each other, for this CDA documents are
transmitted to HL7 message designed for transfer of clinical document.
Fig 1. Process of generating CDA document
PACS Archive
GUI
DICOM
DB
Visual representation of images Extraction of DICOM Tags
Image Retreival
Generate CDA-XML

4. International Journal of Information Technology & Management Information System (IJITMIS),
ISSN 0976 – 6405(Print), ISSN 0976 – 6413(Online) Volume 4, Issue 2, May - August (2013), © IAEME
59
3. PROCEDURE
The research work started with collection of DICOM images. For managing these
images a PACS server was created. Further images were categorized on the basis of their
modalities, orientation and database file of information retrieved from images was
maintained. At last the standard data was converted into XML/HL7 format using CDA.
4. CONCLUSION
An ideal system has been created in which all DICOM images from different
modalities can be stored and this very system brings all doctors from different departments
(neurology, cardiologist, etc) to work together for better study and results. The research
concluded that the HL7 v3 CDA R2 could provide a more scalable interoperable solution.
HL7 v3 CDA has been successfully implemented worldwide. Any clinical systems working
with HL7 standard can send a patient’s information summary to the EHR through the
message gateway, which will translate this HL7 to CCR and send it to the EHR profile
associated with the patient. In case if patient decides to visit another hospital, one which has
no previous record for that person, the same EHR profile can be accessed by the new hospital
system to get all the records of particular patient stored by previous clinical systems.
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