1. IHE Workshop – June 2006What IHE Delivers 1 Cynthia A. Levy Cedara Software IHE Technical Committee Import Reconciliation Workflow Profile

2. IHE Workshop – June 2006 2 Import Reconciliation Workflow Problem Statement The Problem: A Healthcare enterprise is presented with portable patient data (CD, Film) from unknown external sources. The Healthcare enterprise wishes to reconcile patient and study data, and then import this data into the patients electronic health record (EHR).

3. IHE Workshop – June 2006 3 Import Reconciliation Workflow Problem Issues Physical Limitations Security/Administrative: no CD drive in medical workstations Security/Administrative: no CD drive in medical workstations Logistical Limitations Portable Data may include different user interfaces in viewers, some viewers dont work Portable Data may include different user interfaces in viewers, some viewers dont work The clinicians need to archive images temporary or permanent cant be fulfilled The clinicians need to archive images temporary or permanent cant be fulfilled Images not available in Radiology PACS for comparison or second- opinion consult Images not available in Radiology PACS for comparison or second- opinion consult Data Limitations Patient not registered in the HIS Patient not registered in the HIS Patient not registered in the RIS Patient not registered in the RIS

4. IHE Workshop – June 2006 4 Import Reconciliation Workflow Use Case – External Acquisition/Read Radiology Enterprise A Radiology Enterprise B Provider A Radiology Site B PACS A Portable Data Creator Patient Data 2. Radiology Site B creates portable media with patient images and/or Reports 1. Provider A orders External Radiology Procedure 3. Portable Media is sent to Reading Site A via CD. Patient Data is imported and read. 4. Study Results sent to Provider Radiologist PDI Disk

5. IHE Workshop – June 2006 5 Radiology Enterprise B Radiology Enterprise A PACS B Portable Data Creator Patient Data 2.Relevant Data (including film) is collected and Enterprise A creates portable media with patients radiology information. 1. Request for Patients case data to be transferred from Enterprise A to B. 3.Data is transported to Site B via CD. Patient Demographics are reconciled and data is imported into archive. 4. Patient Data is now associated with Bs electronic health record system. Import Reconciliation Workflow Use Case – Patient Referral/Transfer

6. IHE Workshop – June 2006 6 Import Reconciliation Workflow Value proposition Reading and Care Planning Efficiency: easy, dispersed, in context, access to patients data with the familiar user interface by all physicians in the healthcare enterprise. Reduced Cost: no need for training to use new viewers. Quality/Safety: patient and image identifiers are available and consistent Handling Efficiency: reduced handling effort in the patients data for importing process.

7. IHE Workshop – June 2006 7 Import Reconciliation Workflow Scope Import Reconciliation Workflow (IRWF) piggy-backs on Scheduled Workflow (SWF) Import of Evidence Objects regardless of transport mechanism Hardcopy Import (e.g. Films, Documents) Existing Evidence Objects (e.g. CDs, Network) Improved Demographic Integrity Enterprise Patient/Order Information is used to identify the Evidence Objects Original Patient Demographics are preserved within resultant Evidence Objects

8. IHE Workshop – June 2006 8 Import Reconciliation Workflow Requirements Patient must be registered in the HIS Patient Demographics from the Enterprise must be used to reconcile imported data Import may be a Scheduled Order Order information may be used to schedule the import Order information may be used to reconcile imported data Import may be Unscheduled

9. IHE Workshop – June 2006 9 Import Reconciliation Workflow Out of Scope Unregistered Patient This scenario requires proper Patient Registration occur in all of the relevant Systems – HIS, RIS, PACS…

10. IHE Workshop – June 2006 10 Import Reconciliation Workflow Actors/Groupings IRWF introduces one new Actor - Importer The Importer is transport independent, and may need to be grouped: Portable Media Importer may be grouped with the Importer to complete the import of Evidence Objects from a PDI CD No grouping is necessary to import Films using a Digitizer.

11. IHE Workshop – June 2006 11 Import Reconciliation Workflow Options – and Not The Importer must implement at least one of the following options Scheduled Import Unscheduled Import Additionally, the Importer may support Billing and Material Management But Import PPS Exception Management is required in IRWF

12. IHE Workshop – June 2006 12 Import Reconciliation Workflow Scheduled Import Option

13. IHE Workshop – June 2006 13 Import Reconciliation Workflow Scheduled Import Scheduled Import Option supports scheduling of the import. The DICOM Modality Worklist provides information to the Importer about: Enterprise Patient Demographics Critical Attributes such as the Patient Name, Patient ID, Patient Birth Date and Patient Sex Other Patient Ids should be a merge of the Enterprise and Imported Object Enterprise Order Information Critical Attributes such as the Accession Number

14. IHE Workshop – June 2006 14 Import Reconciliation Workflow Transaction used for Scheduled Import RAD-5 Query Modality Worklist provides Patient Demographics and Order information for Scheduled Import and has been enhanced to include Scheduled Procedure Step Description may include instructions on what should be imported Scheduled Procedure Sequence may include instructions on the subsequent use of the instances

15. IHE Workshop – June 2006 15 Import Reconciliation Workflow Scheduled Import Dependencies IRWF depends on Scheduled Workflow Required Actors for Scheduled Import are: Department Scheduler System/Order Filler Image Manager/Image Archive Performed Procedure Step Manager Importer

16. IHE Workshop – June 2006 16 Import Reconciliation Workflow Scheduled Import Transaction Diagram

17. IHE Workshop – June 2006 17 Import Reconciliation Workflow Unscheduled Import Option

18. IHE Workshop – June 2006 18 Import Reconciliation Workflow Unscheduled Import Unscheduled Import Option supports ad hoc importing. An HL7 Patient Demographics Supplier provided to the Importer about Patient Demographics: Critical Attributes such as the Patient Name (PID:5), Patient ID (PID:3), Patient Birth Date (PID:7) and Patient Sex (PID:8) Other Patient Ids (PID:4) should be a merge of the Enterprise and Imported Object

19. IHE Workshop – June 2006 19 Import Reconciliation Workflow Transaction used for Unscheduled Import ITI-21 Patient Demographic Query provides Patient Demographics for Unscheduled Import

20. IHE Workshop – June 2006 20 Import Reconciliation Workflow Unscheduled Import Dependencies IRWF depends on Scheduled Workflow IRWF depends on IT Infrastructure Patient Demographics Query for Unscheduled Import Required Actors for Unscheduled Import are: Patient Demographics Supplier Image Manager/Image Archive Performed Procedure Step Manager Importer

21. IHE Workshop – June 2006 21 Import Reconciliation Workflow Unscheduled Import Transaction Diagram

22. IHE Workshop – June 2006 22 Import Reconciliation Workflow With IRWF, Data Reconciliation is done as part of the Process

23. IHE Workshop – June 2006 23 Import Reconciliation Workflow Import Critical Attributes Critical Patient Demographics and Order Information Attributes come from the Enterprise Critical Study attributes must be maintained from the Imported Objects including: Study Instance UID (when valid) Referenced Study Sequence Scheduled Protocol Code Sequence

24. IHE Workshop – June 2006 24 Import Reconciliation Workflow Import Attribute Difference The actual mapping of attributes into the Resultant IODs and the MPPS depends upon the scenario: Digitized Evidence Objects such as Films will need to be provided Study Instance UIDs and may not contain Original Patient Demographics (unless manually provided) Digital Evidence Objects imported using Scheduled import may contain difference in the Resultant IODs versus the MPPS And more… See RAD-TF:2 Appendix A for all Attribute Mapping

25. IHE Workshop – June 2006 25 Import Reconciliation Workflow Original Import Attributes All Attributes modified during the Import shall be maintained using Original Attribute Sequence A new Original Attribute Sequence is added every time DICOM objects are imported. Original attributes from digitized hardcopy may be manually entered.

26. IHE Workshop – June 2006 26 Import Reconciliation Workflow Contributing Equipment Attributes The Contributing Equipment Sequence is used to maintain information about the Importing Equipment. Type of Equipment used to perform the import Institution performing the import …

27. IHE Workshop – June 2006 27 Import Reconciliation Workflow Common IRWF Transactions The following transactions are required to complete the import: RAD-59 Import Procedure Step In Progress is used to indicate that a Import is in-progress RAD-60 Import Procedure Step Completed is used to indicate that a Import has been completed RAD-61 Imported Objects Stored is used to store the Imported Evidence Objects RAD-10 Storage Commitment ensures Imported Objects are stored

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