IHE Eye Care Appointment Scheduler Linda Wedemeyer, MD Co-Chair, IHE Eye Care Planning Committee Ophthalmologist, Veterans Health Administration Jim Riggi Co-Chair, IHE Eye Care Planning Committee President and CEO, Medflow Inc Rick Butler Co-Chair, IHE Eye Care Technical Committee Senior Software Engineer, Medflow Inc.

Appointment Scheduler Abstract / Scope New for 2010 – Introduces a new profile and two new actors. - Profile – Eye Care Appointment Scheduler - Actors – Appointment Requestor and Appointment Scheduler Integrates physician/practitioner scheduling requests with an integrated and consolidated scheduling system.

Appointment Scheduler Value Proposition Optimizes Resource Scheduling – Allows automated scheduling initiated by Healthcare (HC) Providers – Scheduling managed in a consolidated system – HC Providers able to query for scheduled appointments – Notification of schedule updates Preserve Appointment Request Continuity – Closes the Loop between schedule requests and actual appointments – Manages healthcare provider requests within a global appointment scheduling system.

Appointment Scheduler Value Proposition Improve Workflow Efficiency – Use of Consolidated Appointment Scheduler Eliminate paper routing slips or sticky notes. Enables the scheduler to know and manage future and current appointments Automated Patient Demographics for new patients and updates Follow-up of healthcare provider requests – Hard appointment – Deferred appointment – Cancelled appointments – Rescheduled appointments

Reduces Integration Effort at Site – Get Vendors on the Same Page – Provide Implementation Guidance – Pre-test at Connectathon Scheduled Workflow Value Proposition

Appointment Scheduler Workflow 6 Appointment Requester Appointment Scheduler Requests *NOTE: Scheduled appointments may result in orders (i.e. modality work lists). However, they are outside the scope Response Uses HL7 v Uses HL7 v HC Provider Requests Appointment HC Provider Requests Appointment Appointment Scheduler Schedules Appointments Appointment Scheduler Schedules Appointments - Incorporates details provide - Date/Time – Resource – Etc - Incorporates Patient Feedback Appointment Requester is notified of appointment information Appointment Requester is notified of appointment information Future updates to the appointment are conveyed to Appointment Requester Future updates to the appointment are conveyed to Appointment Requester HC Provider can query for appointments HC Provider can query for appointments

Terminology Eye Care Appointment Scheduling – Integration Profile Name Appointment Requester – Actor responsible for requesting appointments be scheduled Appointment Scheduler – Actor responsible for creating and managing appointments for defined clinical resources Appointment Query – A transaction generated by the Appointment Requester to Appointment Scheduler Determines current scheduling information for defined query criterion Term Placer in HL7 is used to represent IHE Actor Appointment Requester Term Filler in the HL7 is used to represent the IHE Actor Appointment Scheduler

HL7 Standards Used HL7 v2.5.1 All Actors – ADT Messages as defined by RAD-1 and RAD-12 Appointment Request– SRM Messages - Requests that a new appointment be scheduled -SRR Response is sent containing the results of the request Appointment Update – SIU Messages -New: S12 (New Appointment Notification) -Update Appointment: S13 (Appointment has been rescheduled) -Cancel Appointment: S15 (Cancel Appointment) Query Appointment – SQM/SQR Messages -Query: SQM^S25 (Schedule Query Request) -Response: SQR^S25 (Schedule Query Response)

EyeCare Appointment Scheduling Actor Diagram

New Appointment Request Use Case After examining a patient, the Healthcare Provider wishes to see the patient in 3 months for a follow-up exam. Appointment Requester – Triggers an SRM^S25 message to the Appointment Scheduler to request that the patient be scheduled for a follow-up exam in three months. Appointment Scheduler – Collaborates with the patient and schedules a follow-up appointment with the healthcare provider in three months based on open appointments. Triggers an SRR^S01 response containing results.

New Appointment Interaction Diagram

Request for New Appointment (SRM^S25) Note: Certain HL7 optional segments are required based on IHE conditions

Appointment Request Highlights If the Appointment Scheduler has created the appointment(s) related to the request, the Appointment Scheduler shall send the Appointment Requester an SRR response. Segments AIS, AIG, AIL and AIP are noted as optional. However, they become critical to create a query that becomes very specific. IHE requires the support of these segments to allow the implementers the needed tools to create the expressive detail required by the clinic. Therefore they are conditionally required. NTE Segment within the AIG segment shall be implemented by the Appointment Scheduler and Appointment Requester if the clinic deems it necessary to provide the expressive detail

Appointment Request Highlights (Cont.) ARQ – Appointment Request segment is required - ARQ.7 - Appointment Reason contains the identifier code for the reason the appointment is to take place. This field can contain a Universal Service ID. If a Universal Service ID is present, then an AIS segment is required. - ARQ.11 - Request Start Date/Time Range contains the general date and time of the requested appointment (i.e., 2 weeks, 3 months, 1 hour)

Appointment Request Highlights (Cont.) ARQ – Appointment Request segment (Cont.) – ARQ.12- Priority contains the priority of the appointment. This is used to prioritize the appointment request.

Appointment Request Highlights (Cont.) AIS – Appointment Information – Service AIS.11 - Placer Supplemental Service Information shall be implemented by the Appointment Scheduler and Appointment Requester if the clinic deems it necessary to provide additional codified information. AIS.12 - Filler Supplemental Service Information shall be implemented by the Appointment Scheduler and Appointment Requester if the clinic deems it necessary to provide additional codified information.

Appointment Request Highlights (Cont.) TQ1 – Timing and Quantity TQ1.7 - Start date/time shall contain the explicit start date and time of the appointment

Appointment Request Response Request Response (SRR^S01)

Request Response Highlights SCH – Schedule Activity Information Note: The term Placer in the HL7 table is used to represent the IHE Actor Appointment Requester. The term Filler in the HL7 Table is used to represent the IHE Actor Appointment Scheduler. - SCH.1 -Placer Appointment ID shall be filled in with the appointment ID received from the Appointment Requester. This allows the Appointment Requester to link requests with responses from the Appointment Scheduler. - SCH.2 - Filler Appointment ID is required when an appointment has a status code in SCH-Field 25 of Waitlist, Booked, Overbooked or Declined, otherwise this field may be present. This field shall contain the Appointment Schedulers unique ID related to the specific appointment that was created based on a specific request.

Request Response Highlights (Cont.) - SCH.11 - Appointment Timing Quantity has been deprecated. The TQ1 segment is better suited to convey appointment timing and quality related to the specified appointment. It is maintained here for backwards compatibility. - SCH.25 - Filler Status Codes is required to convey the current status of the appointment. HL7 Table 0278 shall be used and has been extended to support the additional appointment status code listed below

Appointment Notifications Appointments may be created, rescheduled and cancelled. Appointment Scheduler broadcasts appointment notifications to subscribing actors, most notably Appointment Requester. If an appointment notification is based upon a previous appointment request (SRM), the Appointment Requester shall link them to the original request. This provides the Appointment Requester the ability to provide information regarding the disposition of an appointment request.

New Appointment (Unsolicited) Use Case A patient contacts the Appointment Scheduler to schedule a new appointment to see Dr. Smith. Appointment Scheduler – Collaborates with the patient and schedules the appointment. This triggers the Appointment Scheduler to send an SIU^S12 message to subscribed actors. Subscribed actors accept the message and process accordingly.

Appointment Notification Interaction Diagram

New Appointment (Unsolicited)

New Appointment (Unsolicited) Highlights Segments AIS, AIG, AIL and AIP shall be implemented by the Appointment Scheduler and Appointment Requester if the clinic deems it necessary to provide the expressive detail. Segments AIS, AIG, AIL and AIP shall be implemented by the Appointment Scheduler and Appointment Requester if the clinic deems it necessary to provide the expressive detail. There is one group (RGS, AIS, AIG, AIL, AIP) per appointment booking per patient. It is repeated when several appointment bookings have been made for the same request for the same patient There is one group (RGS, AIS, AIG, AIL, AIP) per appointment booking per patient. It is repeated when several appointment bookings have been made for the same request for the same patient

Update Appointment (Unsolicited) Use Case A patient contacts the Appointment Scheduler to re-schedule an existing appointment. Appointment Scheduler – Collaborates with the patient and re-schedules the appointment. This triggers the Appointment Scheduler to send an SIU^S13 message to subscribed actors. Subscribed actors accept the message and process accordingly.

Appointment Updates (Unsolicited) Appointment Rescheduling of an Existing Appointments

Appointment Update (Unsolicited) Highlights SCH.1 - Placer Appointment ID is required if the notification is based upon an SRM request message [Appointment Request]

Cancelled Appointment (Unsolicited) Use Case A patient contacts the Appointment Scheduler to cancel an existing appointment. Appointment Scheduler – This triggers the Appointment Scheduler to send an SIU^S15 message to subscribed actors. Subscribed actors accept the message and process accordingly.

Appointment Cancellation Appointment Rescheduling of Existing Appointments

Appointment Cancellation Highlights Appointment cancellation messages (SIU^S15) are constructed in the same manner as S12 and S13 messages. The fact that it is an S15 should suffice to cancel the related appointment(s).

Schedule Query Use Case A clinical employee or Healthcare Provider wishes to review tomorrows schedule. Appointment Requester – triggers an SQM^S25 Schedule Query Message to the Appointment Scheduler. Appointment Scheduler – receives the SQM^S25 and returns an SQR^S25 Schedule Query Response to the Appointment Requester that constants the results of the defined query criterion within the SQM^S25.

Schedule Query

Query for Appointment Information

Schedule Query Highlights Segments ARQ, PID, AIS, AIG, AIL and AIP allows clinics\healthcare providers to provide additional information related to the requests. IHE requires the support of ARQ, PID, AIS, AIG, AIL and AIP segments to allow the implementers the needed tools to create the expressive detail required by the clinic. All of the fields in the segments ARQ, PID, AIS, AIG, AIP and AIL are optional with respect to a query.

Schedule Query Highlights (Cont.) QRD – Query Definition QRD.3 Query Priority shall have the value I for immediate response. Deferred response mode is not supported.

Schedule Query Response Appointment Query Response

Schedule Query Response Highlights There are circumstances where query results are not linked to identifiable patients such as Blocked appointment slots. In those circumstances, the PID segment will not be provided in the query results. Whenever available, the AIS, AIG, AIL and AIP segments shall be returned.

Conclusion EyeCare Appointment Scheduling provides a centralized system to manage resource schedules. - Physician Schedules - Modality Schedules - Other Resource Schedules HL7 Scheduling messages are leveraged to provide a common form of communicating scheduling information between actors.