June 28-29, 2005 IHE - Effective Integration of the Enterprise and the Health System 1 Integrating the Healthcare Enterprise Presentation of Grouped Procedures Charles Parisot, GE Healthcare IHE IT Radiology Planning and Technical Committees

June 28-29, 2005 IHE - Effective Integration of the Enterprise and the Health System 2Agenda Scheduled Workflow: Refresher on critical workflow concepts Scheduled Workflow: Refresher on well identified workflow cases Presentation of Grouped Procedures: Taking the Group Case a step further What should I do as an implementer ? Taking advantage of the new Appendix A

June 28-29, 2005 IHE - Effective Integration of the Enterprise and the Health System 3 Store Images Storage Commitment List of Images PACS & Archive RIS ModalityPerformed Procedure Step Performed Step: Status = Completed Performed CT Head Pat Name/ID, Dose, Accession #, Study UID Complete List of Images A Closed Loop Update IS SchedulingUpdate IS Scheduling Match Procedure with OrderMatch Procedure with Order Support Billing Based on MPPSSupport Billing Based on MPPS Avoid Reading incomplete ProceduresAvoid Reading incomplete Procedures IHE Scheduled Workflow Modality Worklist Worklist Procedure Scheduled Patient Registration/Update Order Management

June 28-29, 2005 IHE - Effective Integration of the Enterprise and the Health System 4 IHE Workflow Concepts Procedure Steps : 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’ IHE identifies four fundamental workflow information units : : A Unit of Reporting Work with associated codified, billable acts REQUESTED PROCEDURE : A Unit of Reporting Work with associated codified, billable acts A request for radiologic service ORDER : A request for radiologic service

June 28-29, 2005 IHE - Effective Integration of the Enterprise and the Health System 5 IHE Workflow is User Driven Information Unit has its Prime User ORDER: A request for imaging service (Accession Number) REQUESTED PROCEDURE : Units of work resulting in one Report with associated codified, billable acts (Requested Procedure ID) PROCEDURE STEP : The smallest unit of work in the workflow (modality worklist entry) CLINICIAN OR REFERING DOC: The Imaging Dept Customer RADIOLOGIST : In Charge of producing the Report the Report TECHNOLOGIST (and RADIOLOGIST) In charge of acquiring images, etc.

June 28-29, 2005 IHE - Effective Integration of the Enterprise and the Health System 6 Normal Workflow Typical workflow: One Order – One Procedure – One Report ORDER A request for Radiologic Service Requested Procedure Radiology Department One or more series of images Report Set of Codifiable, Billable, Acts Acquisition Modality

June 28-29, 2005 IHE - Effective Integration of the Enterprise and the Health System 7 Acquisition Modality Multiple Modality Steps ORDER A request for Radiologic Service Radiology Department Set of Codifiable, Billable, Acts One or more series of images Performed Procedure Step P1 Scheduled Procedure Step B Requested Procedure 1 Scheduled Procedure Step A Report One or more series of images Performed Procedure Step P2 DICOM Modality Worklist

June 28-29, 2005 IHE - Effective Integration of the Enterprise and the Health System 8

June 28-29, 2005 IHE - Effective Integration of the Enterprise and the Health System 9 The Group Case Approach ORDER A request for Radiologic Service CT Chest & Abdomen Radiology Department Acquisition Modality Requested Procedure CT Chest Requested Procedure CT Abdomen Report CT Chest Set of Codifiable, Billable, Acts Report CT Abdo Set of Codifiable, Billable, Acts One or more series of images One Order – Two Procedures – One Acquisition - Two Reports Step

June 28-29, 2005 IHE - Effective Integration of the Enterprise and the Health System 10 Group Case ORDER A request for Radiologic Service Radiology Department Report Set of Codifiable, Billable, Acts Acquisition Modality Report Set of Codifiable, Billable, Acts Requested Procedure 2 Scheduled Procedure Step B Requested Procedure 1 Scheduled Procedure Step A One or more series of images Performed Procedure Step P1 DICOM Modality Worklist

June 28-29, 2005 IHE - Effective Integration of the Enterprise and the Health System 11 Is Grouping of Procedures a common need ? CT Chest/Abdomen/Pelvis Neuroradiology: CT Neck & CT Chest MR Imaging of different sections of the spine MRI and MRA of vessels acquired together MRI of the head and neck with specialized coils Direct radiography (DR) in a trauma patient: AP images, then move the patient once to acquire a set of orthogonal images, and then regroup by body part Sonographic evaluation of the kidneys and of the abdomen CT of the pelvis with CT angiographic runoff Angiographic studies of multiple vessels mixed with therapeutic interventions on selected segments.

June 28-29, 2005 IHE - Effective Integration of the Enterprise and the Health System 12 Why is the Grouping of Procedures a significant need ? Maintain the link back to each one of the grouped procedures without breaking the acquisition apart. Ensure that each image subset related to a requested procedure is identified and ready to be presented. This is key for quick display of new and prior studies. In the film world, images are manually sorted. In the film- less world, images should be sorted automatically when displayed Optimize patient comfortOptimize patient comfort Optimize time of image acquisition.Optimize time of image acquisition. But, there is the need to:

June 28-29, 2005 IHE - Effective Integration of the Enterprise and the Health System 13 Grouping of Procedures in IHE Group Case support is required by the IHE Scheduled Workflow Integration Profile: On Image Managers (PACS) On Order Fillers (RIS). Group Case support is optional on Modalities. PGP requires support of the “Group Case Option” on Modalities.

June 28-29, 2005 IHE - Effective Integration of the Enterprise and the Health System 14 PGP Integration Profile builds upon SWF and CPI Consistent Presentation of Images Softcopy grayscale and presentation state Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps + Presentation of Grouped Procedures Presentation of Subsets of a Single Acquisition Required for

June 28-29, 2005 IHE - Effective Integration of the Enterprise and the Health System 15 MODALITY IHE – Presentation of Grouped Procedures Requested Procedure: CHEST Report: CHEST Requested Procedure: ABDOMEN Report: ABDOMEN Performs a single acquisition Operator groups 2 procedures Chest View Abdomen View RIS / PACS Chest View Abdomen View Scheduled Procedure Step Chest Scheduled Procedure Step Abdo

June 28-29, 2005 IHE - Effective Integration of the Enterprise and the Health System 16 Presentation of Grouped Procedures Improves workflow, overall efficiency of care and reduces costs of providing services: Lowers barriers to migration to digital radiology practice Optimizes use of newer & faster acquisition devices Improves clarity and access to Radiology results Simplifies and facilitates billing of grouped procedures Enhances softcopy interpretation throughput

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June 28-29, 2005 IHE - Effective Integration of the Enterprise and the Health System 18 IHE PGP - Implementation Example Image Display Constraints MODALITY Requested Procedure: CHEST Report: CHEST Requested Procedure: ABDOMEN Report: ABDOMEN Performs a single acquisition Operator groups 2 procedures Chest View Abdomen View Order Filler Chest View Abdomen View Scheduled Procedure Step Chest Scheduled Procedure Step Abdo Image Mgr (Incl. Display) PGP Actors Chest View Abdomen View Image Display CPI only Actor Image Display has no access to full Requested Procedure Information

June 28-29, 2005 IHE - Effective Integration of the Enterprise and the Health System 19 Implementing PGP made easy ! Feedback from early implementors has resulted in significant improvement for the Technical Framework: Appendix A has been entirely restructuredAppendix A has been entirely restructured to provide a thorough and unambiguous specifications of all SWF+PGP workflow cases. The NewAppendix A defines precisely every details for information mappingsThe New Appendix A defines precisely every details for information mappings in modalities between MWL, Images/Presentation States, Modality PPS. This is critical information for PACS and RIS implementations of SWF and PGP.

June 28-29, 2005 IHE - Effective Integration of the Enterprise and the Health System 20 Technical Frameworks: Connectathon results: Vendors Integration Statements: Sponsors Web sites: Chapters World-wide: Questions? W W W.. N E T

June 28-29, 2005 IHE - Effective Integration of the Enterprise and the Health System 21 W W W. I H E. N E T Providers and Vendors Working Together to Deliver Interoperable Health Information Systems in the Enterprise and Across Care Settings