HIMSS/RSNAVendor Workshop, Sep 2004 Notification Options for Scheduled Workflow Feedback...

HIMSS/RSNA Vendor Workshop, Sep 2004

Notification Options forNotification Options forScheduled WorkflowScheduled Workflow

Feedback Enhancements

Andrei LeontievL S Consulting


IHE Radiology Integration ProfilesIHE Radiology Integration Profiles

Patient Info.

Recon-ciliation

Access to Radiology Information

Consistent Present-ation of Images

Basic Security

-

EvidenceDocs

KeyImageNotes

Simple Image & Numeric Reports

Presentation of Grouped Procedures

Post-

Processing Workflow

Reporting Workflow

Charge Posting

Scheduled Workflow

Portable Data for Imaging

NMImage


imagesstored

patientinformation

RIS

examination orders

imagesretrieved

HIS

PACS

procedurescheduled

Prefetch any relevantprior studies

modalityworklist

report

report

Scheduled Workflow ProfileScheduled Workflow Profile

Registration

Orders Placed

Orders Filled

Film

FilmFolder

Image Manager& Archive

FilmLightbox

report ReportRepository

DiagnosticWorkstation

Modality

acquisitionacquisitionin-progressin-progressacquisitioncompleted

acquisitioncompleted

imagesprinted

AcquisitionModality


NEW SWF OptionsNEW SWF OptionsDepartmental Appointment Notification

– Gives the Department System Scheduler an option to notify Order Placer of date and time of scheduled examinations.

Instance Availability Notification – Gives the Image Manager an option to

notify Order Filler and other workflow management actors of availability status of evidence objects.


imagesstored

patientinformation

RIS

examination orders

imagesretrieved

HIS

PACS

procedurescheduled

Prefetch any relevantprior studies

modalityworklist

report

report

Scheduled Workflow ProfileScheduled Workflow Profile

Registration

Orders Placed

Orders Filled

Film

FilmFolder

Image Manager& Archive

FilmLightbox

report ReportRepository

DiagnosticWorkstation

Modality

acquisitionacquisitionin-progressin-progressacquisitioncompleted

acquisitioncompleted

imagesprinted

AcquisitionModality

appointmentnotifications

instanceavailability notification


Departmental Appointment Departmental Appointment Notification OptionNotification Option


Value PropositionValue PropositionProvides a mechanism for the Order

Placer to keep track of appointments scheduled for a patient within Radiology Department

Includes notifications of scheduling, re-scheduling and cancellation events

Helps synchronization of scheduling processes between enterprise and radiology


BackgroundBackground Existing Placer Order Management Transaction

allows Order Placer specify preferred date and time of an order fulfillment (i.e., radiological examination)

Order Filler is ultimately responsible for scheduling of examination as a succession of Procedure Steps that may require one or more appointments to be created

Currently, Order Placer has no way to know when or where exactly the appointment will take place.


Departmental Appointment Departmental Appointment Booking Use CaseBooking Use Case

Order Placer

Image Manager

Placer Order Mgmt – New [2]

Department System Scheduler/ Order Filler

Procedure Scheduled [4]

Create Order

Schedule Procedure Steps and/or Assign Protocol

Appointment Notification - New Bookings [48]

Appointment Notification – Reschedule Bookings [48]

Reschedule Procedure Step(s)

Cancel Procedure or Procedure Steps

Appointment Notification - Cancel Bookings [48]

Procedure Update [13]

Procedure Update [13]


Appointment Notification Appointment Notification TransactionTransaction

Appointment Notification

Order Placer DSS/ Order Filler

Department System Scheduler/Order Filler generates Appointment Notification messages and sends them to the corresponding Order Placer actor.

Order Placer receives Appointment Notification messages and internally processes them.


Interaction DiagramInteraction Diagram Order Placer Order Filler

Appointment Notification – New Bookings (SIU^S12)

Cancel Appointment for Scheduled Procedure Step

Reschedule Appointment for Scheduled Procedure Step

New Appointment for Scheduled Procedure Step

Appointment Notification – Reschedule Bookings (SIU^S13)

Appointment Notification – Cancel Bookings (SIU^S15)


Appointment Notification Appointment Notification TransactionTransaction

Three typical use cases– New booking: initial scheduling of an examination – Re-schedule: change in date/time of examination– Cancellation: examination cancellation

Mechanism– HL7 SIU messages– One message may convey multiple appointments

corresponding to a single order– One appointment corresponds to one or more

Scheduled Procedure Steps


SIU Message StructureSIU Message StructureSIU^S12, SIU^S13, SIU^S15

Schedule Information Unsolicited

Chapter in HL7 V2.4/2.5

MSH

SCH

{ RGS

{ AIS

[ { NTE } ]

}

}

Message Header

Schedule Activity Information

Resource Group Segment

Appt Information – Service

Notes and Comments

2

10

10

10

2


SCH SegmentSCH Segment Specifies common information for one or

more appointments associated with single order– Placer Appointment ID is not used– Filler Appointment ID is required

Appointment timing is defined on the Resource Group level, per Scheduled Procedure Step– SCH-6 has fixed value of 1– One message can have multiple resource groups,

thus multiple appointments (procedure steps) No patient identification information is

required, thus Order Numbers are required


AIS SegmentAIS Segment Specifies Procedure Code and Description to

for the Scheduled Procedure Step(s) included into this appointment– Procedure Code in components 1-3– Not all steps of the procedure may be included– Those included are identified by a the text in

component 5 Date/Time of an appointment is expected to

be in UTC– If local, UTC offset is required

No specification of location or resources (one should use AIG, AIL, AIP segments within the same group, as appropriate)


What is not in the optionWhat is not in the optionDepartmental Appointment Notification

Option does not allow Order Placer to request re-scheduling – it only can do it by cancel and re-order

Transaction does not require AIL segment – thus notifications on re-scheduling of the service from one location to another may not be sent

This option does not address needs of enterprise-wide scheduling


ReferencesReferencesProfile Option - Volume 1, Section 3.3.6Transactions - Volume 3, Section 4.48


Instance Availability Notification Instance Availability Notification OptionOption


Value PropositionValue PropositionEnhances mechanism that allows to

obtain information about availability of newly-acquired images and other evidence objects, for further use in workflow

Provides this information to all workflow management actors


BackgroundBackground DSS/Order Filler, Post-Processing Manager,

Report Manager need to know when acquired evidence objects made it to the Archive– MPPS may be sent before objects are stored, and

storage may fail– MPPS is not available to all “managers”– MPPS may fail or not be sent at all (media import)

Existing query mechanism forces “managers” to poll Image Manager/Archive for availability of SOP Instances.


Use CasesUse CasesThis option only addresses the use

case when MPPS referencing evidence objects has been received by Image Manager.

Image Manager generates Instance Availability Notification upon receiving of all objects referenced in particular MPPS.

Cross-referencing of MPPS in IAN may compensate for MPPS missed by OF


Instance Availability Notification Instance Availability Notification TransactionTransaction

Instance Availability Notification

Image Manager/ Image Archive

DSS/ Order Filler

Post-Processing Manager

Report Manager


Instance Availability Notification Instance Availability Notification TransactionTransaction

Image Manager/Image Archive generates an Instance Availability Notification message and send it to the DSS/Order Filler and optionally to other workflow managing actors (Post-Processing Manager, Report Manager).

DSS/Order Filler, Post-Processing Manager, Report Manager receive an Instance Availability Notification message and internally process it.


Interaction DiagramInteraction Diagram

DSS/ Order Filler

Instance Availability Notification (N-CREATE)

Report Manager

Image Manager

Post-Processing Manager




Instance Availability Notification Instance Availability Notification SOP ClassSOP Class

New SOP Class introduced in DICOM Supplement 93– Normalized Service – N-CREATE Operation only– Can be used without association with MPPS– Does not convey and explicitly forbids adding of

patient or procedure identifiers– Provides list of all object UIDs and their availability

for retrieval, either over network or media (on per-image basis)


Instance Availability Notification Instance Availability Notification SOP ClassSOP Class

New SOP Class introduced in DICOM Supplement 93– No requirements when to generate notifications,

for example: availability of the first instance of a Performed Procedure

Step or Study upon its reception, availability of an entire set of instances comprising a

completed Performed Procedure Step or Study Can be used without association with MPPS

– Is not intended to satisfy scenarios or erroneous information reconciliation (see PIR profile)


Instance Availability ValuesInstance Availability Values “ONLINE” means the instances are immediately available from the

Retrieve AE Title, and if a C-MOVE were to be requested, it would succeed in a reasonably short time

“NEARLINE” means the instances need to be retrieved from relatively slow media such as optical disk or tape, and if a C-MOVE were to be requested from the Retrieve AE Title, it would succeed, but may take a considerable time

“OFFLINE” means that a manual intervention is needed before the instances may be retrieved, and if a C-MOVE were to be requested from the Retrieve AE Title, it would fail (e.g., by timeout) without such manual intervention.

“UNAVAILABLE” means the instances cannot be retrieved from the Retrieve AE Title, and if a C-MOVE were to be requested, it would fail. Note that SOP Instances that are unavailable from this AE may be available from other AEs, or may have an alternate representation that is available from this AE.


Trigger EventsTrigger Events

Image Manager shall send only one IAN message for each MPPS referencing at least one evidence object.

Image Manager shall sent IAN when it received ALL instances referenced in MPPS

Image Manager shall send IAN to DSS/OF, and optionally to other actors


Message SemanticsMessage Semantics Timing of a message can vary significantly

depending on timing of MPPS and object storage

No message may be sent if complete object set never arrives

No message may be sent if objects arrive without corresponding MPPS

Even when objects are included in IAN, the retrieval request may fail due to errors


Expected ActionsExpected Actions Actors receiving IAN message are expected

to use its content for workflow management. Examples of internal actions:

– The Department System Scheduler/Order Filler may update the procedure status internally, indicating that images for the procedure have been stored.

– The Post-Processing Manager may add or re-arrange items to a corresponding worklist.

– The Report Manager add items to a corresponding worklist.


ReferencesReferencesProfile Option - Volume 1, Chapter 3Transactions - Volume 3, Section 4.49


More information….More information…. IHE Web sites:

http://www.himss.org/IHEhttp://www.rsna.org/IHEhttp://www.acc.org/quality/ihe.htm.

Technical Frameworks: ITI V1.0, RAD V5.5, LAB V1.0

Technical Framework Supplements - Trial Implementation May 2004: Radiology August 2004: Cardiology, IT Infrastructure

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


Questions,Questions,

Comments,Comments,

and/orand/or

Suggestions?Suggestions?

HIMSS/RSNAVendor Workshop, Sep 2004 Notification Options for Scheduled Workflow Feedback...

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