1. Presentation of Grouped Procedures Integration Profile Charles Parisot GE Medical Systems IT Planning and Technical Radiology Committees

2. HIMSS/RSNAApril 2003 Workshop Quick Review of Scheduled Workflow 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

3. HIMSS/RSNAApril 2003 Workshop 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

4. HIMSS/RSNAApril 2003 Workshop 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

5. HIMSS/RSNAApril 2003 Workshop 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.

6. HIMSS/RSNAApril 2003 Workshop Acquisition Modality Normal Workflow 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 DICOM Modality Worklist

7. HIMSS/RSNAApril 2003 Workshop 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

8. HIMSS/RSNAApril 2003 Workshop 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 One or more series of images Performed Procedure Step P2 DICOM Modality Worklist Report

9. HIMSS/RSNAApril 2003 Workshop Acquisition Modality Discontinue a Modality Step 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 DICOM Modality Worklist Requested Procedure 2 Scheduled Procedure Step B No Performed Procedure StepDiscontinue DICOM Modality Worklist

10. HIMSS/RSNAApril 2003 Workshop Slide Provided by Gary Wendt, MD

11. HIMSS/RSNAApril 2003 Workshop Acquisition Modality Group Case 2 Requested Procedures but a single Acquisition ORDER A request for Radiologic Service Radiology Department Requested Procedure 1 Requested Procedure 2 One or more series of images Performed Procedure Step P1 Report

12. HIMSS/RSNAApril 2003 Workshop Acquisition Modality Group Case ORDER A request for Radiologic Service Radiology Department Set of Codifiable, Billable, Acts Requested Procedure 1 Scheduled Procedure Step A DICOM Modality Worklist Requested Procedure 2 Scheduled Procedure Step B Set of Codifiable, Billable, Acts One or more series of images Performed Procedure Step P1 Report

13. HIMSS/RSNAApril 2003 Workshop 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.

14. HIMSS/RSNAApril 2003 Workshop Why Grouping of Procedures ? 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 also the need to:

15. HIMSS/RSNAApril 2003 Workshop 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.

16. HIMSS/RSNAApril 2003 Workshop Presentation of Grouped Procedures Subset a single acquisition IHE Integration Profiles Patient Information Reconciliation Unknown patients and unscheduled orders Consistent Presentation of Images Hardcopy and softcopy grayscale and presentation state Access to Radiology Information Consistent access to images and reports Key Image Notes Exchange flagging significant images Simple Image and Numeric Reports Exchange simple reports with image links and, optionally, measurements Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Presentation of Grouped Procedures Subset a single acquisition

17. HIMSS/RSNAApril 2003 Workshop IHE Integration Profiles Patient Information Reconciliation Unknown patients and unscheduled orders Consistent Presentation of Images Hardcopy and softcopy grayscale and presentation state Access to Radiology Information Consistent access to images and reports Key Image Notes Exchange flagging significant images Simple Image and Numeric Reports Exchange simple reports with image links and, optionally, measurements Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Presentation of Grouped Procedures Subset a single acquisition

18. HIMSS/RSNAApril 2003 Workshop 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

19. HIMSS/RSNAApril 2003 Workshop 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

20. HIMSS/RSNAApril 2003 Workshop 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

21. HIMSS/RSNAApril 2003 Workshop Slide Provided by Gary Wendt, MD

22. HIMSS/RSNAApril 2003 Workshop Questions? Documents Available On the Web at: www.rsna.org/IHEwww.rsna.org/IHE