1. Sept 13-15, 2004IHE Interoperability Workshop 1 Integrating the Healthcare Enterprise Presentation of Grouped Procedures Charles Parisot, GE Healthcare IHE IT Radiology Planning and Technical Committees

2. Sept 13-15, 2004IHE Interoperability Workshop 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

3. Sept 13-15, 2004IHE Interoperability Workshop 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

4. Sept 13-15, 2004IHE Interoperability Workshop 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

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

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.

7. Sept 13-15, 2004IHE Interoperability Workshop 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.

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

9. 9 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

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

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

12. Sept 13-15, 2004IHE Interoperability Workshop 12

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

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

15. Sept 13-15, 2004IHE Interoperability Workshop 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.

16. Sept 13-15, 2004IHE Interoperability Workshop 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:

17. Sept 13-15, 2004IHE Interoperability Workshop 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.

18. Sept 13-15, 2004IHE Interoperability Workshop 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

19. Sept 13-15, 2004IHE Interoperability Workshop 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

20. Sept 13-15, 2004IHE Interoperability Workshop 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

21. Sept 13-15, 2004IHE Interoperability Workshop 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

22. Sept 13-15, 2004IHE Interoperability Workshop 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

23. Sept 13-15, 2004IHE Interoperability Workshop 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

24. Sept 13-15, 2004IHE Interoperability Workshop 24

25. Sept 13-15, 2004IHE Interoperability Workshop 25 More information…. IHE Web sites: http://www.rsna.org/IHE 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