Transcript IHE Radiology - Established IHE Integration Profiles

Integrating the Healthcare Enterprise
– Radiology –
Established IHE Integration Profiles:
• Scheduled Workflow (SWF)
• Patient Information Reconciliation (PIR)
Dr. Nikolaus Wirsz – Siemens Medical Solutions
IHE Europe Committee
IHE Radiology Planning Committee
Feb. 07-10, 2005
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IHE Europe Workshop
IHE Radiology Integration Profiles
Charge
Posting
Scheduled Workflow (SWF)
-
Patient
Info.
Reconciliation
Presentation
The 2 Workflow
Basics in PostIHE
of Grouped
Procedures
Processing
Workflow
Reporting
Workflow
(PIR)
NM
Image
Consistent
Presentation of
Images
Evidence
Docs
Key
Image
Notes
Simple
Image &
Numeric
Reports
Access to Radiology Information
Portable Data for Imaging
Basic Security
Feb. 07-10, 2005
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IHE Europe Workshop
Workflow in Radiology – Closing the Loop
report
report
Registration
Report
Repository
report
HIS patient
Diagnostic
Workstation
information
PACS
Film
Lightbox
images
retrieved
Orders Placed
examination orders
RIS
Orders Filled
Feb. 07-10, 2005
procedure
scheduled
Image Manager
Prefetch any relevant
& Archive
prior studies
Acquisition
modality
images
Modality
worklist
stored
acquisition
completed
acquisition
images
in-progress
completed
printed
3
Modality
Film
Folder
Film
IHE Europe Workshop
Summary
Fundamental Starting Point of IHE:
 Scheduled Workflow:
• Registration
• Order Entry & Scheduling
• Acquisition
• Image Storage & Retrieval
 Patient Information Reconciliation:
• Exception Cases (Out of Order Events)
• Information Updates
Bridges HL7 and DICOM Spaces
Basis for Other (Non-Radiology) Specialties:
 Cardiology
 Laboratory
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IHE Europe Workshop
SWF – Overview of Actors & Transactions
ADT
Patient Registration
Patient Registration
Image Creator
Filler Order
Management
Order Placer
Image Display
Storage
Commit
Placer Order
Management
Images
Stored
Q /R
Images
Department
System Scheduler
– Order Filler –
Image Archive
Image Manager
PPS
In-Progress
/ Completed
Storage
Commit
Performed
Procedure Step
Manager
PPS
In-Progress
/ Completed
Modality Worklist
Feb. 07-10, 2005
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Images
Stored
Acquisition
Modality
PPS
In-Progress
/ Completed
IHE Europe Workshop
SWF – Overview of Actors & Transactions
ADT
Patient Registration
Patient Registration
HIS
Image Creator
Filler Order
Management
Order Placer
Image Display
Storage
Commit
Placer Order
Management
Images
Stored
IMAGING:
•PACS
•Workstations
•Modalities
Q /R
Images
Department
System Scheduler
– Order Filler –
Image Archive
Image Manager
RIS
PPS
In-Progress
/ Completed
Storage
Commit
Performed
Procedure Step
Manager
PPS
In-Progress
/ Completed
Modality Worklist
Feb. 07-10, 2005
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Images
Stored
Acquisition
Modality
PPS
In-Progress
/ Completed
IHE Europe Workshop
IHE Scheduled Workflow Concepts
IHE has selected three UNAMBIGUOUS HL7 / DICOM TERMS :
ORDER :
A request for radiologic service
REQUESTED PROCEDURE : Units of work resulting in one Report
with associated codified, billable acts
PROCEDURE STEP :
The smallest unit of work in the workflow:
Scheduled Procedure Step: ‘A unit of work to do’
Performed Procedure Step: ‘A unit of work done’
Feb. 07-10, 2005
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IHE Europe Workshop
Workflow Concept Mapping
The 3-level workflow structure is user-oriented:
ORDER:
A request for imaging service
(Accession Number)
CLINICIAN
OR REFERING DOC:
The Imaging Dept Customer
REQUESTED PROCEDURE :
Units of work resulting in one Report
RADIOLOGIST :
In Charge of producing
the Report
with associated codified, billable acts
(Requested Procedure ID)
TECHNOLOGIST
(and RADIOLOGIST)
In charge of acquiring
images, etc.
PROCEDURE STEP :
The smallest unit of work
in the workflow
(modality worklist entry)
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IHE Europe Workshop
Typical Workflow: 1 Order – 1 Procedure – 1 Report
DICOM
Modality Worklist
ORDER
A request for
Radiologic
Service
Radiology Department
Scheduled
Procedure
Step
Performed
Procedure
Step
Requested
Procedure
One or
more series
of images
Report
Set of
Codifiable,
Billable, Acts
Acquisition
Modality
Feb. 07-10, 2005
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IHE Europe Workshop
Workflow with Multiple Modality Steps
ORDER
A request for
Radiologic
Service
DICOM
Modality Worklist Radiology Department
Scheduled
Procedure
Step A
Performed
Procedure
Step P1
Requested
Procedure
One or
more series
of images
1
Scheduled
Procedure
Step B
Report
Set of
Codifiable,
Billable, Acts
Performed
Acquisition
Procedure
Step P2 Modality
DICOM
Modality Worklist
One or
more series
of images
Acquisition
Modality
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IHE Europe Workshop
IHE
Actors
&
Transactions
in the
Scheduled
Workflow
Profile
→ 1: Pt Registration
ADT
Pt Registration: 1 
Pt Update: 12 
 1: Pt registration
 12: Pt Update

2: Placer Order Management

3: Filler Order Management
Order Placer
Order Filler

6: Modality PPS in Progress
7: Modality PPS Completed
20: Creator PPS in Progress
Master Patient Index
→ 12: Pt Update
4: Procedure Scheduled
11: Image Availability Query
 12: Patient Update
 13: Procedure Update
21: Creator PPS Completed
Image Display
Image Creator

20: Creator PPS in Progress

21: Creator PPS Completed
Storage
Commitment: 10 
Performed
Procedure

18: Creator Image Stored
14: Query Images

19: Creator GSPS Stored
15: Query GSPS

29: Key Image Notes Stored
16: Retrieve Images
17: Retrieve GSPS
Step Manager
30: Query Key Image Notes
31: Retrieve Key Image Notes

Image
Image
Manager
Archive
6: Modality PPS in Progress

7: Modality PPS Completed
IHE Standards Based Transactions

8: Modality Image Stored
20: Creator PPS in Progress

21: Creator PPS Completed
• HL7:
Commitment: 10
- ADT Messages (A01-08, A11-13, A38,Storage
A40)
- ORM Messages

9: Modality GSPS Stored
29: Key Image Notes Stored
6: Modality PPS in Progress
 7: Modality PPS Completed
• DICOM:
- Modality Worklist Management (MWL)

5: Modality Worklist Provided
- Modality Performed Procedure
Step (MPPS)
- Storage, Storage Commitment
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- Query/Retrieve
Acquisition
Modality
IHE Europe Workshop
SWF – Administrative Normal Process Flow
ADT
Order
Placer
Department System
Scheduler/ Order Filler
Image
Manager
Acquisition
Modality
Register/
Admit
Patient
Patient
Registration [1]
Create Order
Placer Order
Mgmt – New [2]
Schedule Procedure and/or
Assign Protocol
Procedure
Scheduled [4]
Modality Worklist
Provided [5]
HL7 Transactions
Feb. 07-10, 2005
DICOM Transactions
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SWF – Procedure Performance Normal Process Flow
Department System
Database/Scheduler
/ Order Filler
Image
Manager
Acquisition
Modality
Image
Archive
Print
Server
Print
Composer
Modality Procedure
Step In Progress [6]
Modality Procedure
Step In Progress [6]
Perform
Acquisition
Modality Images
Stored [8]
Modality Procedure
Step Completed [7 ]
Modality Procedure
Step Completed [7]
Modality Storage
Commitment [10]
Modality
Presentation State
Stored [9]
Print Request [23]
Images Availability
Query [11]
DICOM Transactions
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IHE Europe Workshop
Patient Information Reconciliation – PIR
Expect the Unexpected – Exception Cases:
 Trauma/Emergent Cases
• Patient Unknown or no time for Registration
 Entry Errors by Operator
 Other Demographic Changes
• e.g. Married Name
Multiple sources/destinations for updates
 High risk of unsynchronized / inconsistent data
BUT: Workflow must continue – Extending the SWF
Coordinated update of demographic information
Need to pull together past & current patient records
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IHE Europe Workshop
PIR – Use Cases
Local policy calls for ADT to pre-register ER
patients – “John Doe” / “Jane Doe”:
 Case 1: Unidentified Patient registered at ADT and
order is placed at Order Placer
 Case 2: Unidentified Patient registered at ADT and
order is placed at DSS/Order Filler
 Case 3: Unidentified Patient registered at ADT but
acquisition completed at Modality prior to order
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PIR – Use Cases
Local policy allows departments to register ER
patients with Departmental IDs:
 Case 4: Unidentified Patient assigned temporary
Departmental ID & scheduled at DSS/Order Filler
 Case 5: Image Acquisition completed prior to assigning
temporary Departmental ID or Order
(Patient ID entered at the Modality).
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IHE Europe Workshop
PIR – Case 3 – “Emergency Patient”
Unidentified Patient registered at ADT but acquisition completed at Modality prior to order
Department System
Database/Scheduler/
Order Filler
Order
Placer
ADT
Image
Manager
Modality
Register J.Doe
Images
Acquired
Patient
Registration [1]
Modality Procedure
Step Completed [7]
ModalityProcedure
Step Completed [7]
Filler Order Mgmt
New Order [3]
Schedule Procedure
Procedure
Scheduled [4]
Patient Reconciliation
J.Doe -> J.Smith
Patient
Update [12]
Patient
Update [12]
HL7 Transactions
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DICOM Transactions
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Value Proposition
Preserve Order Continuity
 “Close the Loop”
 Maintain Accession Number, avoid confusion with Filler #, Placer #, etc.
Improve Demographic Integrity
 Data entry errors
• significant occurrence
• significant consequences
 Enter once, pass from system to system
Improve Workflow Efficiency
 Use of Worklists
• less time spent doing data entry/selection
• enables semi-automation of setup
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Value Proposition
Reliable Storage
 Storage Commitment
• fewer lost studies
• more confidence in results
Improve Order Tracking
 MPPS from Modality to RIS & PACS
• more timely & precise feedback
• enable subsequent workflow steps (reporting, billing)
Reduce Integration Effort at Site
 Get Vendors on the Same Page
 Provide Implementation Guidance
 Pre-test at Connectathon
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IHE Europe Workshop
Questions ?
References:
IHE Europe:
http://www.IHE-Europe.org
IHE Main Web Site: http://www. IHE.net
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IHE Europe Workshop