SWF Options/Charge Posting Andrei Leontiev Dynamic Imaging IHE Radiology Planning Committee

June 28-29, 2005IHE Interoperability Workshop2 Scheduled Workflow Options Multiple options Scheduled Workflow Profile allow certain degree of workflow “tune-up” –Managing Workflow: Patient-based or Broad Worklist Queries, Assisted Protocol Setting, Exception Management, Billing and Material Management –Notifications of Performed Work Status or Availability of Results: Images, Other Evidence documents, Appointments

June 28-29, 2005IHE Interoperability Workshop3 Modality Options in SWF Transaction Diagram

June 28-29, 2005IHE Interoperability Workshop4 Assisted Protocol Option Value Proposition Gives the Department System Scheduler an option to directly control protocol settings on the Modality. Reduces variance on how procedures are performed Centralizes configuration effort

June 28-29, 2005IHE Interoperability Workshop5 Assisted Protocol Option Definition Actors Affected –Modality –Order Filler/DSS –Image Manager/Archive –Report Manager Transactions Affected –PPS In-Progress Standards Used –DICOM (Modality Worklist and MPPS)

June 28-29, 2005IHE Interoperability Workshop6 Assisted Protocol Option Mechanism Mechanism –Order Filler/DSS passes Scheduled Protocol Codes to the Acquisition Modality inside the Modality Worklist Item (DICOM) –Modality configuration is set accordingly either automatically or manually accepted/modified by operator –Modality populates Performed Protocol Code information in MPPS –The Protocol Code tables in all actors have to be synchronized

June 28-29, 2005IHE Interoperability Workshop7 PPS Exception Management Option Value Proposition Provides better feedback on discontinued studies Handles selection of wrong worklist item

June 28-29, 2005IHE Interoperability Workshop8 PPS Exception Management Option Definition Actors Affected –Modality –Order Filler/DSS –Image Manager/Archive –Report Manager Transactions Affected –PPS Completed Standards Used –DICOM (MPPS)

June 28-29, 2005IHE Interoperability Workshop9 Exception Management Option Mechanism Mechanism –Provision of Discontinue Reason Code in PPS Completed transaction: Doctor cancelled procedure Equipment failure Incorrect procedure ordered Patient allergic to media/contrast Patient died Patient refused to continue procedure Patient taken for treatment or surgery Patient did not arrive Patient pregnant Change of procedure for correct charging Duplicate order Nursing unit cancel Incorrect side ordered Discontinued for unspecified reason Incorrect worklist entry selected Patient condition prevented continuing

June 28-29, 2005IHE Interoperability Workshop10 Appointment Notification Value Proposition Provides a mechanism for the Order Placer to keep track of appointments scheduled for a patient within Radiology Department Includes notifications of scheduling, re-scheduling and cancellation events Helps synchronization of scheduling processes between enterprise and radiology

June 28-29, 2005IHE Interoperability Workshop11 Appointment Notification Option Definition Actors Affected –Order Filler/DSS –Order Placer Standards Used –HL7 v. 2.4 SIU messages Transactions affected –Appointment Notification

June 28-29, 2005IHE Interoperability Workshop12 Appointment Notification Option Mechanism Mechanism –One appointment corresponds to one or more Scheduled Procedure Steps –Department System Scheduler/Order Filler generates Appointment Notification messages and sends them to the corresponding Order Placer actor. –One message may convey multiple appointments corresponding to a single order –Order Placer receives Appointment Notification messages and internally processes them.

June 28-29, 2005IHE Interoperability Workshop13 Appointment Notification Option Details Specifies common information for one or more appointments associated with single order Appointment timing is defined on the per Scheduled Procedure Step level –One message can have multiple appointments (procedure steps) No patient identification information is required, thus Order Numbers are required Specifies Procedure Code and Description –Not all steps of the procedure may be included Date/Time of an appointment is expected to be in UTC –If local, UTC offset is required

June 28-29, 2005IHE Interoperability Workshop14 What is not in the option Departmental Appointment Notification Option does not allow Order Placer to request re-scheduling – it only can do it by cancel and re-order Transaction does not require AIL segment – thus notifications on re-scheduling of the service from one location to another may not be sent This option does not address needs of enterprise-wide scheduling

June 28-29, 2005IHE Interoperability Workshop15 Instance Availability Notification Value Proposition Enhances mechanism that allows to obtain information about availability of newly-acquired images and other evidence objects, for further use in workflow. Avoids “performance penalty” of Instance Availability query mechanism that forces “managers” to poll Image Manager/Archive for availability of evidence objects. Provides this information to all workflow management actors.

June 28-29, 2005IHE Interoperability Workshop16 Instance Availability Notification Option Definition Actors Affected –Image Manager/Archive –Order Filler/DSS –Post-Processing Manager –Report Manager Standards Used –DICOM (Instance Availability Notification SOP Class; Supplement 93 Final Text) Transactions affected –Instance Availability Notification

June 28-29, 2005IHE Interoperability Workshop17 Instance Availability Notification Option Mechanism Mechanism –Image Manager/Image Archive generates an Instance Availability Notification message and send it to the DSS/Order Filler and optionally to other workflow managing actors (Post-Processing Manager, Report Manager). –DSS/Order Filler, Post-Processing Manager, Report Manager receive an Instance Availability Notification message and internally process it..

June 28-29, 2005IHE Interoperability Workshop18 Instance Availability Values “ONLINE” –the instances are immediately available from the Retrieve AE Title, and if a C-MOVE were to be requested, it would succeed in a reasonably short time “NEARLINE” –the instances need to be retrieved from relatively slow media such as optical disk or tape, and if a C-MOVE were to be requested from the Retrieve AE Title, it would succeed, but may take a considerable time

June 28-29, 2005IHE Interoperability Workshop19 Instance Availability Values “OFFLINE” –manual intervention is needed before the instances may be retrieved, and if a C-MOVE were to be requested from the Retrieve AE Title, it would fail (e.g., by timeout) without such manual intervention. “UNAVAILABLE” –the instances cannot be retrieved from the Retrieve AE Title, and if a C-MOVE were to be requested, it would fail. Note that SOP Instances that are unavailable from this AE may be available from other AEs, or may have an alternate representation that is available from this AE.

June 28-29, 2005IHE Interoperability Workshop20 Instance Availability Notification Option Details Image Manager shall send only one IAN message for each MPPS referencing at least one evidence object. Image Manager shall sent IAN when it received ALL instances referenced in MPPS Timing of a message can vary significantly depending on timing of MPPS and object storage No message may be sent if complete object set never arrives No message may be sent if objects arrive without corresponding MPPS Even when objects are included in IAN, the retrieval request may fail due to errors

June 28-29, 2005IHE Interoperability Workshop21 Instance Availability Notification Option Details Actors receiving IAN message are expected to use its content for workflow management. Examples of internal actions: –The Department System Scheduler/Order Filler may update the procedure status internally, indicating that images for the procedure have been stored. –The Post-Processing Manager may add or re-arrange items to a corresponding worklist. –The Report Manager may add items to a corresponding worklist.

June 28-29, 2005IHE Interoperability Workshop22 What is not in the option This option only addresses the use case when MPPS referencing evidence objects has been received by Image Manager. Image Manager generates Instance Availability Notification upon receiving of all objects referenced in particular MPPS. Cross-referencing of MPPS in IAN may compensate for MPPS missed by OF

June 28-29, 2005IHE Interoperability Workshop23 Charge Posting Abstract / Scope The Department System Scheduler/Order Filler provides the procedure data that is used by the Charge Processor to generate claims and submit them to payors. –Fees associated with the procedures may be defined by the Department System Scheduler/Order Filler or by the Charge Processor. –Claim/Bill creation from charges and communication with payors is out of scope of the profile

June 28-29, 2005IHE Interoperability Workshop24 Charge Posting Value Proposition Standardizes data exchange of charges from radiology to the financial systems Reduces the need of the billing system to have knowledge of the radiology internals. Charge Processor receives more complete, timely and accurate data.

June 28-29, 2005IHE Interoperability Workshop25 Charge Posting Transaction Diagram

June 28-29, 2005IHE Interoperability Workshop26 Charge Posting Standards Used Health Level Seven, Version 2.3.1: Chapter 6 - Financial Management –DFT^P03 message DICOM 2003 PS 3.4 Modality Performed Procedure Step SOP Class –Billing and Materials Management module – allows Modality specify billing information, including material consumption (contrast, film, etc.)

June 28-29, 2005IHE Interoperability Workshop27 More information…. IHE Web site: Technical Frameworks Technical Framework Supplements – Trial Implementation Non-Technical Brochures : –Calls for Participation –IHE Fact Sheet and FAQ –IHE Integration Profiles: Guidelines for Buyers –IHE Connect-a-thon Results –Vendor Products Integration Statements Questions?