1. Feb. 07-10, 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)

2. Feb. 07-10, 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

3. Feb. 07-10, 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

4. Feb. 07-10, 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

5. Feb. 07-10, 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

6. Feb. 07-10, 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

7. Feb. 07-10, 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

8. Feb. 07-10, 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.

9. Feb. 07-10, 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

10. Feb. 07-10, 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

11. Feb. 07-10, 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

12. Feb. 07-10, 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

13. Feb. 07-10, 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

14. Feb. 07-10, 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

15. Feb. 07-10, 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

16. Feb. 07-10, 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).

17. Feb. 07-10, 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

18. Feb. 07-10, 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

19. Feb. 07-10, 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

20. Feb. 07-10, 2005IHE Europe Workshop 20 References: IHE Europe:http://www.IHE-Europe.org IHE Main Web Site:http://www. IHE.net Questions ?