1. IHE Radiology Integration Profiles: ▪ Post-Processing Workflow ▪ Reporting Workflow IHE Educational Workshop – June 11-13, 2007 Nikolaus Wirsz, PhD Manager IT Standards / Siemens Medical Solutions IHE Radiology Planning Committee

2. IHE Radiology Integration Profiles Patient Information Reconciliat ion Reconcile worklists, status, and data objects for unknown patients and demographics changes Access to Radiology Information - Consistent access to images and reports Consistent Presentation of Images Manage, retrieve & use objects for hardcopy and softcopy grayscale presentation states Key Image Notes Create, store, manage, retrieve & use objects to flag significant images Simple Image and Numeric Reports Manage simple diagnostic reports with optional images, measurements Scheduled Workflow Presentation of Grouped Procs Manage individual procedure image subsets from a multi-procedure acquisition for viewing & reporting Charge Posting Collect and post timely billable procedure details ITI ATNA – Radiology Option (Replaces Basic Security) Reporting Workflow Manage worklists, track status, perform & notify diagnostic reporting steps Evidence Documents Manage, retrieve & use objects to record study evidence Manage worklists, track status, perform & notify image processing & CAD steps Post- Processing Workflow Manage worklists, track status, perform & notify acquisition related step, create, store, manage, retrieve & use images NM Image Create, store, manage, retrieve & use NM image objects Portable Data for Imaging - Consistent access to images and reports on CD Media Admit, Order, Schedule Teaching Files & Clinical Trials Export Standardize Clinical Trial Data and Anonymization XDS for Imaging - Sharing of Imaging Information across health enterprises Billing Teaching/ Research Contents & DisplayCommon InfrastructureWorkflows

3. IHE Radiology Integration Profiles Patient Information Reconciliat ion Reconcile worklists, status, and data objects for unknown patients and demographics changes Access to Radiology Information - Consistent access to images and reports Consistent Presentation of Images Manage, retrieve & use objects for hardcopy and softcopy grayscale presentation states Key Image Notes Create, store, manage, retrieve & use objects to flag significant images Simple Image and Numeric Reports Manage simple diagnostic reports with optional images, measurements Scheduled Workflow Presentation of Grouped Procs Manage individual procedure image subsets from a multi-procedure acquisition for viewing & reporting Charge Posting Collect and post timely billable procedure details ITI ATNA – Radiology Option (Replaces Basic Security) Evidence Documents Manage, retrieve & use objects to record study evidence Manage worklists, track status, perform & notify acquisition related step, create, store, manage, retrieve & use images NM Image Create, store, manage, retrieve & use NM image objects Portable Data for Imaging - Consistent access to images and reports on CD Media Admit, Order, Schedule Teaching Files & Clinical Trials Export Standardize Clinical Trial Data and Anonymization XDS for Imaging - Sharing of Imaging Information across health enterprises Billing Teaching/ Research Contents & DisplayCommon InfrastructureWorkflows PPWFRWF Reporting Workflow Manage worklists, track status, perform & notify diagnostic reporting steps Manage worklists, track status, perform & notify image processing & CAD steps Post- Processing Workflow

4. Extension to the Scheduled Workflow to Support Typical Reporting Workflow Tasks: –Interpretation –Dictation –Transcription –Verification –Review –Comparison Ability to Schedule and Track the Status of Reporting Tasks Reporting Workflow (RWF) – Summary

5. Reporting Worklist Work Item Claimed Reporting Procedure Step STARTED Store Reports Report Manager RIS Image Manager/ Archive PACS & Archive Report Reader/Creator Retrieve Images & Evidence Documents Measurements CAD Reports ………………… Released (Completed) Reporting Workflow (RWF) – Overview Reporting Procedure Step COMPLETED Reporting Procedure Step STARTED Reporting Procedure Step COMPLETED

6. Reporting Actors: –Reporting Manager –Report Creator / Report Reader –Report Repository Transactions: –Reporting Worklist Provided –Work Item Claimed –Work Item PPS In Progress –Work Item PPS Completed –Work Item Completed –Performed Work Status Update –Retrieve Images / Evidence Documents –Submit / Retrieve / Issue Reports RWF – Actors & Transactions

7. Report Manager Grouped with Image Manager IM/IA Report Manager Performed Work Status Update (optional) DSS/OF Report Manager NOT Grouped Report Manager IM/IADSS/OF Report Manager Grouped with DSS/OF DSS/OF Report Manager IM/IA Performed Work Status Update RWF – Report Manager Grouping

8. DSS/OF Image Display Report Creator/ Report Reader Reporting Worklist Provided Work Item Claimed Retrieve Images Retrieve Evidence Documents IM/IA Work Item PPS In Progress Work Item PPS Completed Work Item Completed Images Available Performed Work Status Update Report Submission RWF – Actors & Transactions Report Manager

9. Report Creator finds out what tasks have been scheduled / assigned by the Reporting Manager Worklist provided for Work Item codes e.g.: –Interpretation –Transcription –Verification RWF – Reporting Worklist Provided

10. General Purpose Worklist SOP Class Explicit definition of required matching and return keys for both Report Manager and Report Creator Report Creator implements at least one the following query cases: –PatientOriented Query: Worklist for a specific patient / procedure –UserOriented Query: Worklist for a particular user Report Manager Report Creator C-FIND-RQ C-FIND-RSP RWF – Reporting Worklist Provided

11. Report Creator takes ownership of the Work Item Report Manager updates its worklist and permits other worklist users to detect that this SPS has been claimed Report Manager Report Creator N-ACTION (GP-SPS in Progress) RWF – Work Item Claimed

12. Report Creator starts working on the claimed Work Item N-CREATE (GP-PPS in Progress) Report Manager Report Creator RWF – Procedure Step in Progress

13. Report Creator notifies Reporting Manager of PPS completion Report Creator references any created results N-CREATE (GP-PPS Completed) Report Manager Report Creator RWF – Procedure Step Completed

14. Report Creator notifies the Reporting Manager when it completes the scheduled Work Item and releases ownership of the Work Item Report Manager updates its worklist N-ACTION (SPS Completed) Report Manager Report Creator RWF – Work Item Completed

15. General Purpose Performed Procedure Step SOP Class Report Manager informs other actors of the creation and status update of the performed reporting task Allows the systems not managing the performed work to stay in sync Report Manager DSS/OF IM/IA N-CREATE (PPS in Progress) N-SET (PPS Completed) RWF – Performed Work Status Update

16. Improve Reporting Workflow Efficiency – Use of Worklists to Manage Reporting Tasks Eliminate Errors Associated with Paper and Film Handling Close the Information Loop - Proper Association of Reports with: –Corresponding Order –Acquired Images –Other Clinical Evidence Enable direct access to images and evidence documents to be interpreted Enable access to prior reports and old images Reporting Workflow – Value Proposition

17. Extension to the Scheduled Workflow to Support Typical Post-Processing Workflow Tasks: –Image Processing –Image Reconstruction –Computer Aided Detection –3D View Generation –Quality Control Ability to Schedule and Track the Status of Post- Processing Tasks Post-Processing Workflow (PPWF) – Summary

18. Post-Processing Worklist Retrieve Images Store Reports Measurements CAD Reports ……....……… Archive Images Post-Processing Procedure Step STARTED Work Item Claimed Post-Processing Procedure Step STARTED Image & Post-Proc. Manager RIS Departmental System Scheduler Order Filler Completed Post-Processing Workflow (PPWF) – Overview 3D Workstation PACS & Archive Post-Processing Procedure Step COMPLETED Post-Processing Procedure Step COMPLETED

19. Acquisition Modality Modality and Post-Processing Steps ORDER A request for Radiological Service Radiology Department Set of Codifiable, Billable Acts One or more series of images M-Perf. Procedure Step P1 Requested Procedure 1 Scheduled Procedure Step B Scheduled Procedure Step A Report DICOM Modality Worklist DICOM Post-Processing Worklist Post- Processing One or more series of images PP-Perf. Procedure Step P2

20. Additional Actor: –Post-Processing Manager Transactions: –Worklist Provided –Work Item Claimed –Work Item PPS In Progress –Work Item PPS Completed –Work Item Completed –Performed Work Status Update –Evidence Documents Stored –Query Evidence Documents –Retrieve Evidence Documents PPWF – Actors & Transactions

21. Post-Processing Manager Grouped with Image Manager (PACS) Post-Processing Manager IM/IA DSS/OF Performed Work Status Update (optional) PPWF – Post-Processing Manager Grouping Post-Processing Manager Grouped with Departmental System Scheduler / Order Filler (RIS) IM/IA Performed Work Status Update Post-Processing Manager DSS/OF

22. Image Display Evidence Creator Image Availability Query Performed Work Status Update Worklist Provided Work Item Claimed Work Item PPS In Progress Work Item PPS Completed Work Item Completed Retrieve Images Query Evidence Documents Retrieve Evidence Documents Images Stored Storage Commitment Evidence Documents Stored IM/IA Query Images PPWF – Actors & Transactions Post-Processing Manager

23. Evidence Creator finds out what post-processing tasks have been scheduled or assigned to it by the Post-Processing Manager Worklist provided for Work Item codes e.g. Image Processing or Computer Aided Detection Evidence Creator includes received information in the resulting instances PPWF – Worklist Provided

24. General Purpose Worklist SOP Class Explicit definition of required matching and return keys for both Post-Processing Manager and Evidence Creator Evidence Creator shall implements at least one of 3 query cases: –PatientOriented Query:Worklist for a specific patient / procedure –StationOriented Query:Broad Worklist for a particular workstation –ClassOriented Query:Broad Worklist for a class of workstations (e.g. workstations for CT 3D Reconstructions) Post-Processing Manager Evidence Creator C-FIND-RQ C-FIND-RSP PPWF – Worklist Provided

25. Evidence Creator takes ownership of the Work Item Post-Processing Manager updates its worklist and permits other worklist users to detect that this SPS has been claimed PPWF – Work Item Claimed General Purpose Scheduled Procedure Step SOP Class N-ACTION (SPS in Progress) Post-Processing Manager Evidence Creator

26. Evidence Creator starts work on claimed SPS Notifies Post-Processing Manager to create a Performed Procedure Step PPWF – Work Item Performed Procedure Step in Progress General Purpose Performed Procedure Step SOP Class SPS and PPS relationships (Appendix III-D): –Simple Case –Unscheduled Case –Append Case –Abandoned Case N-CREATE (PPS in Progress) Post-Processing Manager Evidence Creator

27. Evidence Creator notifies Post-Processing Manager of the PPS completion Evidence Creator references any results created e.g. images, evidence documents PPWF – Work Item Performed Procedure Step Completed General Purpose Performed Procedure Step SOP Class Evidence Creator shall send to the Post-Processing Manager a list of all Composite SOP Instances in the Output Information Sequence (0040,4033) N-SET (PPS Completed) Post-Processing Manager Evidence Creator

28. Evidence Creator notifies the Post-Processing Manager when it completes the scheduled Work Item Post-Processing Manager updates its worklist PPWF – Work Item Completed General Purpose Scheduled Procedure Step SOP Class No further PPS will be created for this SPS N-ACTION (SPS Completed) Post-Processing Manager Evidence Creator

29. Department System Scheduler and Image Manager inform each other of the status of performed post-processing work Allows the system not managing the performed work to stay in sync PPWF – Performed Work Status Update General Purpose Performed Procedure Step SOP Class IM/IA DSS/OF N-CREATE (PPS in Progress) N-SET (PPS Completed) DSS/OF IM/IA N-CREATE (PPS in Progress) N-SET (PPS Completed)

30. Wrap Up Post-Processing Workflow (Multiple Steps) with Post-Processing Manager Grouped with Image Manager RIS PACS Modality DICOM MWL DICOM Image Storage DICOM Storage Commitment DICOM MPPS DICOM MPPS CAD Station Post-Processing Station DICOM PP-WL DICOM PP-SPS DICOM PP-WL DICOM PP-SPS DICOM PP-PPS DICOM PP-PPS DICOM PP-PPS DICOM Storage & Commitment DICOM Q/R DICOM Storage & Commitment

31. Improve Post-Processing Workflow Efficiency – Use of Worklists to Manage Post-Processing Tasks Eliminate Errors Associated with Paper and Film Handling Close the Information Loop: –Integrating Post-Processing Results with Acquired Images –Associate Post-Processing Results with Correct Order Enable Sub-sequent Workflow Steps: –Initiate Reporting Workflow –Support for Billing Based on Post-Processing Results Post-Processing Workflow – Value Proposition

32. IHE Radiology Integration Profiles Patient Information Reconciliat ion Reconcile worklists, status, and data objects for unknown patients and demographics changes Access to Radiology Information - Consistent access to images and reports Consistent Presentation of Images Manage, retrieve & use objects for hardcopy and softcopy grayscale presentation states Key Image Notes Create, store, manage, retrieve & use objects to flag significant images Simple Image and Numeric Reports Manage simple diagnostic reports with optional images, measurements Scheduled Workflow Presentation of Grouped Procs Manage individual procedure image subsets from a multi-procedure acquisition for viewing & reporting Charge Posting Collect and post timely billable procedure details ITI ATNA – Radiology Option (Replaces Basic Security) Evidence Documents Manage, retrieve & use objects to record study evidence Manage worklists, track status, perform & notify acquisition related step, create, store, manage, retrieve & use images NM Image Create, store, manage, retrieve & use NM image objects Portable Data for Imaging - Consistent access to images and reports on CD Media Admit, Order, Schedule Teaching Files & Clinical Trials Export Standardize Clinical Trial Data and Anonymization XDS for Imaging - Sharing of Imaging Information across health enterprises Billing Teaching/ Research Contents & DisplayCommon InfrastructureWorkflows PPWFRWF Reporting Workflow Manage worklists, track status, perform & notify diagnostic reporting steps Manage worklists, track status, perform & notify image processing & CAD steps Post- Processing Workflow