 Pt. Registration [1]  Patient Update [12] Pt. Registration [1]  Patient Update [12]   Placer Order Management [2]  Filler Order Management [3] ADT  Query Images [14]  Retrieve Images [16] Image Display Storage Commitment [10]   Modality Image Stored [8] Storage Commitment [10]   Creator Evidence Stored [18]  Procedure Scheduled [4]  Image Availability Query [11]  Procedure Updated [13]  Performed Work Status Update [42]   Query Modality Worklist [5] Evidence Creator Performed Procedure Step Manager  Modality PS in Progress [6]  Modality PS Completed [7]  Creator PS in Progress [20]  Creator PS Completed [21]  Modality PS in Progress [6]  Modality PS Completed [7]  Creator PS in Progress [20]  Creator PS Completed [21]  Modality PS in Progress [6]  Modality PS Completed [7]  Creator PS in Progress [20]  Creator PS Completed [21] Order Placer Acquisition Modality Object Manager Object Archive DSS/ Order Filler Query Demographics   Modality Evidence Stored  Patient Update [12] Radiology Scheduled Workflow + Patient Information Reconciliation - Evidence Creator + Cath workflow mods

    Pt. Registration [1]  Patient Update [12] Pt. Registration [1]  Patient Update [12]   Placer Order Management [2]  Filler Order Management [3] ADT  Query Images [14]  Retrieve Images [16] Image Display Modality Image Stored [8] Storage Commitment [10]  Procedure Scheduled [4]  Procedure Updated [13]  Query Modality Worklist [5] Performed Procedure Step Manager  Modality PS in Progress [6]  Modality PS Completed [7]  Modality PS in Progress [6]  Modality PS Completed [7]  Modality PS in Progress [6]  Modality PS Completed [7] Order Placer Acquisition Modality Object Manager Object Archive DSS/ Order Filler Query Demographics  Modality Evidence Stored  Patient Update [12] Radiology Scheduled Workflow + Patient Information Reconciliation - Evidence Creator + Cath workflow mods

Query Modality Worklist [5] ADT Order Placer Object Manager Acquisition Modality Placer Order Mgmt - New [2]– Department System Scheduler/ Order Filler Procedure Scheduled [4] Register/ Admit Patient Create Order Schedule Procedure Patient Registration [1] Administrative Process Flow

Object Manager/ Object Archive Acquisition Modality Department System Scheduler/ Order Filler Modality Procedure Step Completed [7] Perform Acquisition Modality Images Stored [8] Modality Evidence Stored Storage Commitment [10] Modality Procedure Step In Progress [6] Modality Procedure Step Completed [7] Modality Procedure Step In Progress [6] Order Placer Order Status Update [3] Procedure Performance Process Flow

Query Modality Worklist [5] ADT Order Placer Register J.Doe Object Manager Acquisition Modality Placer Order Management– New [2] Patient Reconciliation Department System Scheduler/ Order Filler Schedule Procedure Procedure Scheduled [4] Modality Procedure Step Completed [7] J.Doe -> J.Smith Patient Update/ Merge [12] Images/Evidence Acquired Modality Procedure Step Completed [7] Patient Registration [1] Patient Update/ Merge [12] Case 1: Unidentified Patient Registered at ADT and Ordered at the Order Placer

Case 2: Unidentified Patient Registered at ADT and Ordered at Department System Scheduler/Order Filler Patient Update/ Merge [12] Patient Registration [1] Register J.Doe Query Modality Worklist [5] ADT Order Placer Object Manager Acquisition Modality Filler Order Management - New [3] Patient Reconciliation Department System Scheduler/ Order Filler Schedule Procedure Procedure Scheduled [4] J.Doe –> J.Smith Images/Evidence Acquired Modality Procedure Step Completed [7] Modality Procedure Step Completed [7] Patient Update/ Merge [12]

Case 3: Unidentified Patient Registered at ADT and Procedure Not Ordered (also Case 3A: Known Patient Registered at ADT but Procedure Not Ordered) Patient Update/ Merge [12] Patient Registration [1] Register J.Doe Query Modality Worklist [5] (patient ID) ADT Order Placer Object Manager Acquisition Modality Filler Order Management - New [3] Patient Reconciliation Department System Scheduler/ Order Filler Auto-create Procedure Scheduled [4] J.Doe –> J.Smith Images/Evidence Acquired Modality Procedure Step Completed [7] Modality Procedure Step Completed [7] Patient Update/ Merge [12] Patient ID (wristband) Case 3A: Skip Patient Reconciliation

Case 4: Patient Not Registered at ADT (also Case 4A: ADT Not Available at DSS/OF and Patient ID not Available at Modality) Query Modality Worklist [5] ADT Order Placer Object Manager Acquisition Modality Department System Scheduler/ Order Filler Procedure Scheduled [4] Images/Evidence Acquired Modality Procedure Step Completed [7] Modality Procedure Step Completed [7] Query Demographics Auto-assign Temp Patient ID Patient Registration [1] Register J.Smith Filler Order Management - New [3] Patient Update/ Merge [12] Patient Reconciliation Procedure Update [13] Auto-create Procedure Case 4A: Skip Auto-assign Temp Patient ID; Skip Patient Reconciliation

Object Manager/ Object Archive Acquisition “Modality” Department System Scheduler/ Order Filler Detailed Multi-Modalities Acquisition Modality Acquisition Modality [Hemo- dynamics] [X-ray Angio] Query Modality Worklist [5] Modality Procedure Step In Progress [6] (Cath case) Query Modality Worklist [5] Modality Procedure Step In Progress [6] (Cath Lab) Modality Procedure Step Completed [7] (XA) Modality Procedure Step In Progress [6] (Hemo) Modality Procedure Step In Progress [6] (XA) Modality Images Stored [8 (XA)] Modality Evidence Stored (Hemo) Modality Procedure Step Completed [7] (Hemo) Query Modality Worklist [5] Modality Procedure Step Completed [7] (Cath Lab) Modality Procedure Step Completed [7] (Cath case) [Holding Area & Recovery] Modality Evidence Stored (QCVA) Notes: MPPSs also go to Object Manager; Storage Commitment not shown; Cath Case start / stop may be local function of DSS/OF

Procedure Logging Procedure Log Entry (AMDs, H&P reference; vital signs) Procedure Log Entry (YEAR 2) Procedure Log Stored Create Log Object Close Log Object Modality Procedure Step In Progress [6] (Cath case) Modality Procedure Step Completed [7] (Cath case) Procedure Log Entry Object Manager/ Object Archive Acquisition “Modality” Department System Scheduler/ Order Filler Detailed Multi-Modalities with Procedure Logging Acquisition Modality Acquisition Modality [Hemo- dynamics] [X-ray Angio] Query Modality Worklist [5] Modality Procedure Step In Progress [6] (Cath case) Query Modality Worklist [5] Modality Procedure Step In Progress [6] (Cath Lab) Modality Procedure Step Completed [7] (XA) Modality Procedure Step In Progress [6] (Hemo) Modality Procedure Step In Progress [6] (XA) Modality Images Stored [8 (XA)] Modality Evidence Stored (Hemo) Modality Procedure Step Completed [7] (Hemo) Query Modality Worklist [5] Modality Procedure Step Completed [7] (Cath Lab) Modality Procedure Step Completed [7] (Cath case) [Holding Area & Recovery] Modality Evidence Stored (QCVA) Create Log Entry