IHE Workshop – February 2007 What IHE Delivers 1 Credits for many slides to: Cynthia A. Levy, Cedara Software IHE Technical Committee Import Reconciliation Workflow Profile Peter Mildenberger University Hospital Mainz DRG, ESR, DSC Marco Eichelberg OFFIS IHE – D Technical Manager

IHE Workshop – February Import Reconciliation Workflow Clinical Background Documentation and Imaging digital (HIS/RIS/PACS) Transfer of informations with film, CD, … Availability of these informations at different points, like OP, ICU, ED, Radiology… Many Films and CDs each day in all institutions  Uncoordinated workflow  Time consuming if physicians handle the media themselves handle the media themselves

IHE Workshop – February Import Reconciliation Workflow Problem Issues Physical Limitations  Security/Administrative: no CD drive in medical workstations Logistical Limitations  Portable Data may include different user interfaces in viewers, some viewers don’t work  The clinician’s need to archive images temporary or permanent can’t be fulfilled  Images not available in Radiology PACS for comparison or second- opinion consult Data Limitations  Patient not registered in the HIS  Patient not registered in the RIS

IHE Workshop – February Import Reconciliation Workflow Use Case – External Acquisition/Read Radiology Enterprise A Radiology Enterprise B Provider A Radiology Site B PACS A Portable Data Creator Patient Data 2. Radiology Site B creates portable media with patient images and/or Reports 1. Provider A orders External Radiology Procedure 3. Portable Media is sent to Reading Site A via CD. Patient Data is imported and read. 4. Study Results sent to Provider Radiologist PDI Disk

IHE Workshop – February Radiology Enterprise B Radiology Enterprise A PACS B Portable Data Creator Patient Data 2.Relevant Data (including film) is collected and Enterprise A creates portable media with patient’s radiology information. 1. Request for Patient’s case data to be transferred from Enterprise A to B. 3.Data is transported to Site B via CD. Patient Demographics are reconciled and data is imported into archive. 4. Patient Data is now associated with B’s electronic health record system. Import Reconciliation Workflow Use Case – Patient Referral/Transfer

IHE Workshop – February Import Reconciliation Workflow Value proposition Reading and Care Planning Efficiency: easy, dispersed, in context, access to patient’s data with the familiar user interface by all physicians in the healthcare enterprise. Reduced Cost: no need for training to use new viewers. Quality/Safety: patient and image identifiers are available and consistent Handling Efficiency: reduced handling effort in the patient’s data for importing process.

IHE Workshop – February Import Reconciliation Workflow Scope Import Reconciliation Workflow (IRWF) piggy-backs on Scheduled Workflow (SWF) Import of Evidence Objects regardless of transport mechanism  Hardcopy Import (e.g. Films, Documents)  Existing Evidence Objects (e.g. CDs, Network) Improved Demographic Integrity  Enterprise Patient/Order Information is used to identify the Evidence Objects  Original Patient Demographics are preserved within resultant Evidence Objects

IHE Workshop – February Import Reconciliation Workflow Requirements Patient must be registered in the HIS  Patient Demographics from the Enterprise must be used to reconcile imported data Import may be a Scheduled Order  Order information may be used to schedule the import  Order information may be used to reconcile imported data Import may be Unscheduled

IHE Workshop – February Import Reconciliation Workflow Out of Scope Unregistered Patient This scenario requires proper Patient Registration occur in all of the relevant Systems – HIS, RIS, PACS…

IHE Workshop – February Import Reconciliation Workflow Actors/Groupings IRWF introduces one new Actor - Importer The Importer is transport independent, and may need to be grouped:  Portable Media Importer may be grouped with the Importer to complete the import of Evidence Objects from a PDI CD  No grouping is necessary to import Films using a Digitizer.

IHE Workshop – February Import Reconciliation Workflow Options – and Not The Importer must implement at least one of the following options  Scheduled Import  Unscheduled Import Additionally, the Importer may support  Billing and Material Management But  Import PPS messages (esp. Exception Management) are required in IRWF

IHE Workshop – February Import Reconciliation Workflow Scheduled Import Option

IHE Workshop – February Import Reconciliation Workflow Scheduled Import Scheduled Import Option supports scheduling of the import. The DICOM Modality Worklist provides information to the Importer about:  Enterprise Patient Demographics Critical Attributes such as the Patient Name, Patient ID, Patient Birth Date and Patient Sex Other Patient Ids should be a merge of the Enterprise and Imported Object  Enterprise Order Information Critical Attributes such as the Accession Number

IHE Workshop – February Import Reconciliation Workflow Transaction used for Scheduled Import RAD-5 Query Modality Worklist provides Patient Demographics and Order information for Scheduled Import and has been enhanced to include  Scheduled Procedure Step Description may include instructions on what should be imported  Scheduled Procedure Sequence may include instructions on the subsequent use of the instances

IHE Workshop – February Import Reconciliation Workflow Scheduled Import Dependencies IRWF depends on Scheduled Workflow Required Actors for Scheduled Import are:  Department Scheduler System/Order Filler  Image Manager/Image Archive  Performed Procedure Step Manager  Importer

IHE Workshop – February Import Reconciliation Workflow Scheduled Import Transaction Diagram

IHE Workshop – February Import Reconciliation Workflow Scheduled Import Workflow Diagram

IHE Workshop – February Import Reconciliation Workflow Unscheduled Import Option

IHE Workshop – February Import Reconciliation Workflow Unscheduled Import Unscheduled Import Option supports ad hoc importing. An HL7 Patient Demographics Supplier provided to the Importer about Patient Demographics:  Critical Attributes such as the Patient Name (PID:5), Patient ID (PID:3), Patient Birth Date (PID:7) and Patient Sex (PID:8)  Other Patient Ids (PID:4) should be a merge of the Enterprise and Imported Object ITI-21 Patient Demographic Query provides Patient Demographics for Unscheduled Import

IHE Workshop – February Import Reconciliation Workflow Unscheduled Import Dependencies IRWF depends on Scheduled Workflow IRWF depends on IT Infrastructure Patient Demographics Query for Unscheduled Import Required Actors for Unscheduled Import are:  Patient Demographics Supplier  Image Manager/Image Archive  Performed Procedure Step Manager  Importer

IHE Workshop – February Import Reconciliation Workflow Unscheduled Import Transaction Diagram

IHE Workshop – February Import Reconciliation Workflow Unscheduled Import Workflow Diagram

IHE Workshop – February Import Reconciliation Workflow With IRWF, Data Reconciliation is done as part of the Process

IHE Workshop – February Import Reconciliation Workflow Import Critical Attributes Critical Patient Demographics and Order Information Attributes come from the Enterprise Critical Study attributes must be maintained from the Imported Objects including:  Study Instance UID (when valid)  Referenced Study Sequence  Scheduled Protocol Code Sequence

IHE Workshop – February Import Reconciliation Workflow Import Attribute Difference The actual mapping of attributes into the Resultant IODs and the MPPS depends upon the scenario:  Digitized Evidence Objects such as Films will need to be provided Study Instance UIDs and may not contain Original Patient Demographics (unless manually provided)  Digital Evidence Objects imported using Scheduled import may contain difference in the Resultant IODs versus the MPPS  And more… See RAD-TF:2 Appendix A for all Attribute Mapping

IHE Workshop – February Import Reconciliation Workflow Original Import Attributes All Attributes modified during the Import shall be maintained using Original Attribute Sequence A new Original Attribute Sequence is added every time DICOM objects are imported. Original attributes from digitized hardcopy may be manually entered.

IHE Workshop – February Import Reconciliation Workflow Contributing Equipment Attributes The Contributing Equipment Sequence is used to maintain information about the Importing Equipment.  Type of Equipment used to perform the import  Institution performing the import …

IHE Workshop – February Import Reconciliation Workflow Common IRWF Transactions The following transactions are required to complete the import:  RAD-59 Import Procedure Step In Progress is used to indicate that a Import is in-progress  RAD-60 Import Procedure Step Completed is used to indicate that a Import has been completed  RAD-61 Imported Objects Stored is used to store the Imported Evidence Objects  RAD-10 Storage Commitment ensures Imported Objects are stored

IHE Workshop – February

IHE Workshop – February Import Reconciliation Workflow Common IRWF Transactions

IHE Workshop – February Import Reconciliation Workflow Common IRWF Transactions