IHE Radiology Integration Profiles:▪ Post-Processing Workflow▪ Reporting Workflow

IHE Educational Workshop – June 11-13, 2007IHE Educational Workshop – June 11-13, 2007

Nikolaus Wirsz, PhD Nikolaus Wirsz, PhD Manager IT Standards / Siemens Medical SolutionsManager IT Standards / Siemens Medical SolutionsIHE Radiology Planning CommitteeIHE Radiology Planning Committee

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 ImagesManage, 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

ReportsManage simple

diagnostic reports with

optional images,

measurements

Scheduled Workflow

Presentation of Grouped ProcsManage 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 & Display

Common Infrastructure

Workflows

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 ImagesManage, 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

ReportsManage simple

diagnostic reports with

optional images,

measurements

Scheduled Workflow

Presentation of Grouped ProcsManage 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 & Display

Common Infrastructure

Workflows

PPWF RWF

Reporting Workflow

Manage worklists, track status, perform

& notify diagnostic

reporting steps

Manage worklists, track status, perform & notify image processing & CAD steps

Post-Processing Workflow

• Extension to the Scheduled Workflow toSupport Typical Reporting Workflow Tasks:– Interpretation– Dictation– Transcription– Verification– Review– Comparison

• Ability to Schedule and Track the Status of Reporting Tasks

Reporting Workflow (RWF) – Summary

Reporting WorklistReporting Worklist

Work Item ClaimedWork Item Claimed

ReportingProcedure Step

STARTED

Store ReportsStore Reports

ReportManager

RIS

ImageManager/Archive

PACS & Archive

Report Reader/Creator

Retrieve Images &Retrieve Images &Evidence DocumentsEvidence Documents

MeasurementsCAD Reports…………………

Released (Completed)Released (Completed)

Reporting Workflow (RWF) – Overview

ReportingProcedure Step

COMPLETED

ReportingProcedure Step

STARTED

ReportingProcedure Step

COMPLETED

• 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

• 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/IAPerformed Work Status Update

RWF – Report Manager Grouping

DSS/OF

Image Display

Report Creator/Report ReaderReporting 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

• 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 documentsto be interpreted

• Enable access to prior reports and old images

Reporting Workflow – Value Proposition

• Extension to the Scheduled Workflow to SupportTypical 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

Post-ProcessingWorklist

RetrieveImages

StoreReports Measurements

CAD Reports……....……… Archive

Images

Post-ProcessingProcedure Step

STARTED

Work Item Claimed

Post-ProcessingProcedure Step

STARTED

Image &Post-Proc.Manager

RISDepartmentalSystem SchedulerOrder Filler

Completed

Post-Processing Workflow (PPWF) – Overview

3D Workstation PACS & Archive

Post-ProcessingProcedure Step

COMPLETED

Post-ProcessingProcedure Step

COMPLETED

AcquisitionModality

Modality and Post-Processing Steps

ORDERA request for RadiologicalService

Radiology Department

Set of Codifiable,

Billable ActsOne or more series of images

M-Perf.Procedure

Step P1RequestedProcedure

1

ScheduledProcedure

Step B

ScheduledProcedure

Step A

Report

DICOMModality Worklist

DICOMPost-Processing Worklist

Post-Processing

One or more series of images

PP-Perf.Procedure

Step P2

• 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

• 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

DSS/OF

ImageDisplay

Evidence Creator

Imag

e A

vail

abil

ity

Qu

ery

Per

form

ed W

ork

Sta

tus

Up

dat

e

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

Wrap UpPost-Processing Workflow (Multiple Steps)

with Post-Processing Manager Grouped with Image Manager

RIS PACS

Modality

DICOM MWL

DICOM Image StorageDICOM Storage CommitmentDICOM MPPS

DICOM MPPS

CAD StationPost-Processing

Station

DICOMPP-WL

DICOMPP-SPS

DICOMPP-WL

DICOMPP-SPS

DICOM PP-PPS

DICOM PP-PPS

DICOMPP-PPSDICOM

PP-PPS

DICOM Storage& Commitment

DICOMQ/R

DICOMQ/R

DICOM Storage& Commitment

• 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

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 ImagesManage, 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

ReportsManage simple

diagnostic reports with

optional images,

measurements

Scheduled Workflow

Presentation of Grouped ProcsManage 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 & Display

Common Infrastructure

Workflows

PPWF RWF

Reporting Workflow

Manage worklists, track status, perform

& notify diagnostic

reporting steps

Manage worklists, track status, perform & notify image processing & CAD steps

Post-Processing Workflow