Feb , 2005IHE Europe Workshop 1 Integrating the Healthcare Enterprise – Radiology – Established IHE Integration Profiles: Dr. Nikolaus Wirsz –Siemens Medical Solutions IHE Europe Committee IHE Radiology Planning Committee Scheduled Workflow (SWF) Patient Information Reconciliation (PIR)

Feb , 2005IHE Europe Workshop 2 IHE Radiology Integration Profiles Patient Info. Recon- ciliation (PIR) Access to Radiology Information Consistent Present- ation of Images Basic Security - Evidence Docs Key Image Notes Simple Image & Numeric Reports Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting Scheduled Workflow (SWF) Portable Data for Imaging NM Image The 2 Workflow Basics in IHE

Feb , 2005IHE Europe Workshop 3 Workflow in Radiology – Closing the Loop Registration Orders Placed Orders Filled Film Folder Image Manager & Archive Film Lightbox report Report Repository Diagnostic Workstation Modality acquisition in-progress acquisition completed images printed Acquisition Modality

Feb , 2005IHE Europe Workshop 4 Summary Fundamental Starting Point of IHE:  Scheduled Workflow: Registration Order Entry & Scheduling Acquisition Image Storage & Retrieval  Patient Information Reconciliation: Exception Cases (Out of Order Events) Information Updates Bridges HL7 and DICOM Spaces Basis for Other (Non-Radiology) Specialties:  Cardiology  Laboratory

Feb , 2005IHE Europe Workshop 5 SWF – Overview of Actors & Transactions Order Placer ADT Patient Registration Image Archive Image Manager Image Display Image Creator Acquisition Modality Department System Scheduler – Order Filler – Modality Worklist Patient Registration Procedure ScheduledInstance Availability Query / Notification Images Stored Storage Commit Storage Commit Images Stored PPS In-Progress / Completed Filler Order Management Placer Order Management Q /R Images Performed Procedure Step Manager PPS In-Progress / Completed PPS In-Progress / Completed

Feb , 2005IHE Europe Workshop 6 SWF – Overview of Actors & Transactions Order Placer ADT Patient Registration Image Archive Image Manager Image Display Image Creator Acquisition Modality Department System Scheduler – Order Filler – Modality Worklist Patient Registration Procedure ScheduledInstance Availability Query / Notification Images Stored Storage Commit Storage Commit Images Stored PPS In-Progress / Completed Filler Order Management Placer Order Management Q /R Images Performed Procedure Step Manager PPS In-Progress / Completed PPS In-Progress / Completed RIS HIS IMAGING: PACS Workstations Modalities

Feb , 2005IHE Europe Workshop 7 IHE Scheduled Workflow Concepts PROCEDURE STEP : 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 has selected three UNAMBIGUOUS HL7 / DICOM TERMS : ORDER : A request for radiologic service REQUESTED PROCEDURE : Units of work resulting in one Report with associated codified, billable acts

Feb , 2005IHE Europe Workshop 8 Workflow Concept Mapping The 3-level workflow structure is user-oriented: 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 TECHNOLOGIST (and RADIOLOGIST) In charge of acquiring images, etc.

Feb , 2005IHE Europe Workshop 9 Typical Workflow: – 1 Procedure – 1 Report Typical Workflow: 1 Order – 1 Procedure – 1 Report Acquisition Modality ORDER A request for Radiologic Service Radiology Department Set of Codifiable, Billable, Acts One or more series of images Performed Procedure Step Requested Procedure Scheduled Procedure Step Report DICOM Modality Worklist

Feb , 2005IHE Europe Workshop 10 Workflow with Multiple Modality Steps Acquisition Modality 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 DICOM Modality Worklist Acquisition Modality One or more series of images Performed Procedure Step P2

Feb , 2005IHE Europe Workshop 11  1: Pt registration  12: Pt Update Pt Registration: 1  Pt Update: 12   2: Placer Order Management  3: Filler Order Management ADT  14: Query Images  15: Query GSPS  16: Retrieve Images  17: Retrieve GSPS  30: Query Key Image Notes  31: Retrieve Key Image Notes Image Display Storage Commitment: 10   8: Modality Image Stored  9: Modality GSPS Stored  29: Key Image Notes Stored Storage Commitment: 10   18: Creator Image Stored  19: Creator GSPS Stored  29: Key Image Notes Stored  4: Procedure Scheduled  11: Image Availability Query  12: Patient Update  13: Procedure Update  5: Modality Worklist Provided Image Creator Performed Procedure Step Manager Image Manager Image Archive  6: Modality PPS in Progress  7: Modality PPS Completed  20: Creator PPS in Progress  21: Creator PPS Completed  6: Modality PPS in Progress  7: Modality PPS Completed  20: Creator PPS in Progress  21: Creator PPS Completed  6: Modality PPS in Progress  7: Modality PPS Completed  20: Creator PPS in Progress  21: Creator PPS Completed Order Placer Order Filler Acquisition Modality → 1: Pt Registration → 12: Pt Update Master Patient Index IHE Actors & Transactions in the Scheduled Workflow Profile IHE Standards Based Transactions HL7: -ADT Messages (A01-08, A11-13, A38, A40) -ORM Messages DICOM: -Modality Worklist Management (MWL) -Modality Performed Procedure Step (MPPS) -Storage, Storage Commitment -Query/Retrieve

Feb , 2005IHE Europe Workshop 12 SWF – Administrative Normal Process Flow Modality Worklist Provided [5] ADT Order Placer Image Manager Acquisition Modality Placer Order Mgmt– New [2] Department System Scheduler/ Order Filler Procedure Scheduled [4] Register/ Admit Patient Create Order Schedule Procedure and/or Assign Protocol Patient Registration [1] HL7 TransactionsDICOM Transactions

Feb , 2005IHE Europe Workshop 13 SWF – Procedure Performance Normal Process Flow Image Manager Acquisition Modality Department System Database/Scheduler / Order Filler Image Archive Modality Procedure Step Completed [7] Perform Acquisition Modality Images Stored [8] Modality Presentation State Stored [9] Modality Storage Commitment [10] Modality Procedure Step In Progress [6] Images Availability Query [11] Modality Procedure Step Completed[7] Modality Procedure Step In Progress [6] Print Composer Print Request [23] Print Server DICOM Transactions

Feb , 2005IHE Europe Workshop 14 Patient Information Reconciliation – PIR Expect the Unexpected – Exception Cases:  Trauma/Emergent Cases Patient Unknown or no time for Registration  Entry Errors by Operator  Other Demographic Changes e.g. Married Name Multiple sources/destinations for updates  High risk of unsynchronized / inconsistent data BUT: Workflow must continue – Extending the SWF Coordinated update of demographic information Need to pull together past & current patient records

Feb , 2005IHE Europe Workshop 15 PIR – Use Cases Local policy calls for ADT to pre-register ER patients – “John Doe” / “Jane Doe”:  Case 1:Unidentified Patient registered at ADT and order is placed at Order Placer  Case 2:Unidentified Patient registered at ADT and order is placed at DSS/Order Filler  Case 3:Unidentified Patient registered at ADT but acquisition completed at Modality prior to order

Feb , 2005IHE Europe Workshop 16 PIR – Use Cases Local policy allows departments to register ER patients with Departmental IDs:  Case 4:Unidentified Patient assigned temporary Departmental ID & scheduled at DSS/Order Filler  Case 5:Image Acquisition completed prior to assigning temporary Departmental ID or Order (Patient ID entered at the Modality).

Feb , 2005IHE Europe Workshop 17 PIR – Case 3 – “Emergency Patient” ADT Order Placer Image Manager Modality Department System Database/Scheduler/ Order Filler Filler Order Mgmt New Order [3] Procedure Scheduled [4] Patient Reconciliation J.Doe ->J.Smith Patient Update [12] Schedule Procedure Images Acquired ModalityProcedure Step Completed [7] Modality Procedure Step Completed [7] RegisterJ.Doe Patient Update [12] Patient Registration [1] Unidentified Patient registered at ADT but acquisition completed at Modality prior to order HL7 TransactionsDICOM Transactions

Feb , 2005IHE Europe Workshop 18 Value Proposition Preserve Order Continuity  “Close the Loop”  Maintain Accession Number, avoid confusion with Filler #, Placer #, etc. Improve Demographic Integrity  Data entry errors significant occurrence significant consequences  Enter once, pass from system to system Improve Workflow Efficiency  Use of Worklists less time spent doing data entry/selection enables semi-automation of setup

Feb , 2005IHE Europe Workshop 19 Value Proposition Reliable Storage  Storage Commitment fewer lost studies more confidence in results Improve Order Tracking  MPPS from Modality to RIS & PACS more timely & precise feedback enable subsequent workflow steps (reporting, billing) Reduce Integration Effort at Site  Get Vendors on the Same Page  Provide Implementation Guidance  Pre-test at Connectathon

Feb , 2005IHE Europe Workshop 20 References: IHE Europe: IHE Main Web Site: IHE.net Questions ?