February 8, 2005IHE Europe Educational Event 1 Integrating the Healthcare Enterprise Presentation of Grouped Procedures Charles Parisot, GE Healthcare IHE IT Radiology Planning and Technical Committees

February 8, 2005IHE Europe Educational Event 2 IHE Integration profiles Patient Informa- tion Reconci- liation Access to Radiology Information Consistent Presentation of Images Scheduled Workflow Basic Security - Evidence Documents Key Image Notes Simple Image and Numeric Reports Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting

February 8, 2005IHE Europe Educational Event 3 IHE Integration profiles Patient Informa- tion Reconci- liation Access to Radiology Information Consistent Presentation of Images Basic Security - Evidence Documents Key Image Notes Simple Image and Numeric Reports Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting Scheduled Workflow

February 8, 2005IHE Europe Educational Event 4 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

February 8, 2005IHE Europe Educational Event 5 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 fundemental 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

February 8, 2005IHE Europe Educational Event 6 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.

February 8, 2005IHE Europe Educational Event 7 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.

February 8, 2005IHE Europe Educational Event 8 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

February 8, 2005IHE Europe Educational Event 9 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

February 8, 2005IHE Europe Educational Event 10 Acquisition Modality Multiple Modality Steps (Append) ORDER A request for Radiologic Service Radiology Department Set of Codifiable, Billable, Acts One or more series of images Performed Procedure Step P1 Requested Procedure 1 Scheduled Procedure Step A Report One or more series of images Performed Procedure Step P2 DICOM Modality Worklist

February 8, 2005IHE Europe Educational Event 11 Acquisition Modality Discontinued Procedure Step ORDER A request for Radiologic Service Radiology Department One or more series of images Performed Procedure Step P1 Report Set of Codifiable, Billable, Acts Requested Procedure 2 Scheduled Procedure Step C Requested Procedure 1 Scheduled Procedure Step A DICOM Modality Worklist No Performed Procedure Step Discontinue

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February 8, 2005IHE Europe Educational Event 13 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

February 8, 2005IHE Europe Educational Event 14 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

February 8, 2005IHE Europe Educational Event 15 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.

February 8, 2005IHE Europe Educational Event 16 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:

February 8, 2005IHE Europe Educational Event 17 Grouping of Procedures in IHE Group Case support is required by the IHE Scheduled Workflow Integration Profile on Image Managers (PACS) and Order Fillers (RIS). Its support is optional on Modalities.

February 8, 2005IHE Europe Educational Event 18 IHE Integration profiles Patient Informa- tion Reconci- liation Access to Radiology Information Consistent Presentation of Images Scheduled Workflow Basic Security - Evidence Documents Key Image Notes Simple Image and Numeric Reports Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting

February 8, 2005IHE Europe Educational Event 19 IHE Integration profiles Patient Informa- tion Reconci- liation Access to Radiology Information Consistent Presentation of Images Scheduled Workflow Basic Security - Evidence Documents Key Image Notes Simple Image and Numeric Reports Post- Processing Workflow Reporting Workflow Charge Posting Presentation of Grouped Procedures

February 8, 2005IHE Europe Educational Event 20 IHE Integration profiles Patient Informa- tion Reconci- liation Access to Radiology Information Scheduled Workflow Basic Security - Evidence Documents Key Image Notes Simple Image and Numeric Reports Post- Processing Workflow Reporting Workflow Charge Posting Presentation of Grouped Procedures Consistent Presentation of Images

February 8, 2005IHE Europe Educational Event 21 IHE Integration Profiles 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

February 8, 2005IHE Europe Educational Event 22 MODALITY IHE – Presentation of Grouped Procedures Requested Procedure: CHEST Report: CHEST Requested Procedure: ABDOMEN Report: ABDOMEN Performs a single exam Operator groups 2 procedures Chest View Abdomen View RIS / PACS Chest View Abdomen View Scheduled Procedure Step Chest Scheduled Procedure Step Abdo

February 8, 2005IHE Europe Educational Event 23 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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February 8, 2005IHE Europe Educational Event 25 More information…. IHE Web sites: Technical Frameworks: RAD V5.5 Technical Framework Supplements - Trial Implementation May 2004: Radiology 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