1. Critical Results Reporting

2. 2Created by xxx - 25 January 2006 Use case: “NOW notification” This is a Priority interrupt Drop what you're doing, react now your patient may die today, e.g., pneumothorax A chest X-ray reveals a pneumothorax The reading radiologist immediately Obtains provider information for patient, from imaging order information. Obtains notification information for the provider(s) involved. Sends NOW notifications by all identified methods. Sends NOW notifications by all identified methods. (Page, Office, Nursing station) Tries to locate patient Sends NOW notification to patient location ER Physician responds to page, and accepts responsibility Treats patient Closes out patient NOW issue later. Radiologist Notes that ER Physician has taken responsibility. Closes out NOW notifications. ER Nursing station Responds to message, is informed of ER Physician that has been notified and accepted responsibility.

3. 3Created by xxx - 25 January 2006 “NOW” notification Notification SenderPWPNotification RepositoryNotification Recipient NOW Event Find Notification Methods SMS Call Office Page Call Nursing Stn Call Exam Room Multiple Log events (for each attempt) Returns Page Log success on page, log closure on SMS, Office call, nursing call, exam room call Log Success and Completion On page. An hour or two later After treating patient? Same person? Different person? Issue multiple Notification NOW Find Patient Patient Locator

4. 4Created by xxx - 25 January 2006 Use case: “later” notification This should not interrupt the patient treatment Schedule a follow-up, your patient might die next year, e.g., suspicious lung mass. Chest X-ray to check for broken ribs after traffic accident reveals suspicious lung mass. Radiologist Writes Report, finishes order Obtains notification information for “later” notifications for that provider. Patient’s internist is listed. Sends a “later” notification to the internist, indicating the relevant report to read. Internist Receives notification. Retrieves report, takes responsibility, notifies radiologist of accepting responsibility. Interacts with patient and begins followup. Notifies radiologist that patient has been informed and follow-up begun, closing the “later” notification.

5. 5Created by xxx - 25 January 2006 “Later” notification Notification SenderPWPNotification RepositoryNotification Recipient “later” Event Reports finished Find Notification Method NAV Log attempt (for NAV) Responds with Acceptance Log Acceptance of responsibility Issue notification Reports results Log Acceptance of reports Log receipt (for NAV) Patient Interaction

6. 6Created by xxx - 25 January 2006 Find Information for critical results notification Find Information Who should be notified How can they be notified This will be relevant for both “Now” and “Later” notifications, but with perhaps different information needs. Likely Approaches PWP Are additional fields needed or optionality affected?

7. 7Created by xxx - 25 January 2006 Find Information for critical results notification PWP Server Notification Information Query Actor ITI -24 Query/Display/ Report Requirements

8. 8Created by xxx - 25 January 2006 Reporting requirements Log Notification Activity Successful Notifications Unsuccessful Notifications Use of notification Other? Reporting Notification Activity Outstanding Notification Problems Notification Information Query Actor What queries are mandatory? Optional? How to handle extensibility? What display capability is mandatory? Optional?

9. 9Created by xxx - 25 January 2006 Log Activity Likely Standard: Syslog-TLS Use ATNA? ATNA reliability, access, and security needs can be different from the needs of logging notification activity The decision whether to use the same server for both should be a deployment decision. Federation requirement? Schema must be defined, perhaps stealing a lot of content from ATNA.

10. 10Created by xxx - 25 January 2006 Log Activity Local Repository Any Notification Activity ITI-XX1, Log Notification Activity Successes Failures Other Notification Log Query/Report Actor Time Period Patient Related Provider (person, group, etc.) Outstanding Issues Success/ Outstanding Central Repository ITI-XX1 ITI-XX2, Query Notification Activity

11. 11Created by xxx - 25 January 2006 Notification Log Queries Reporting Notification Activity Outstanding Notification Problems

12. 12Created by xxx - 25 January 2006 Notification methods NAV (ITI-25, 26, 27, 28) SMS Voice Fax Pager XDS Other What is appropriate and ready for IHE to specify in an interoperability profile? Transports Content Profile