IHE Radiology Scheduled Workflow for Import

Peter Kuzmak, Cindy Levy, Dr. Ruth Dayhoff and Andrew Casertano

November 2005

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Problem Statement : Data importing from external sources

Importing Institution

Image Archive/ Image Manager

Patient Data

Patient Data on Removable Media

Film, Paper

Data Import

There is a high level of frustration in the import and review of clinical data by importing institution providers. How do deal with outside identifiers, unknown patients, missing or misidentified data, referrals, non-standard formats, film, screen prints etc?

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The Problem Described: References

The US Department of Veterans Affairs, “Importing DICOM Objects from Portable Media into PACS – the VA Solution”, abstract accepted for SCAR 2006

Groningen University Hospital and ETIAM, The Netherlands, “Incorporating Out-Patient Data From CD-R Into the Local PACS Using DICOM Worklist Features”, Journal of Digital Imaging, Sept 2005

Groningen University Hospital The Netherlands, “A new outpatient with PACS data on CD, now what?”, presented at EuroPACS-MIR, 2004

University of Texas, Anderson Cancer Center of Texas, “Importation of CD-based Image Studies into PACS: Initial Experience”, presented at SCAR 2005.

Existing Profiles such as Scheduled Workflow, Patient Reconciliation and Portable Data for Imaging are a great start but not a complete

resolution.

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IHE Solution

What is Needed?•Define minimum requirements to ensure that importing is as robust as acquisition through Scheduled Workflow.•Patient Information Reconciliation must be integral to the importing process. •Throughout the entire process, the ability to maintain the original attributes in the DICOM header so that one can trace the origin.

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Actors

Acquisition Modality (as hardcopy importer)• Same as in current Radiology Framework with updated

– Modality Procedure Step in Progress – Modality Images Stored

Portable Media Importer• Same as in current Radiology Framework with updated

– Imported Procedure Step in Progress– Imported Images Stored

Image Manager/ Image Archive• Same as in current Radiology Framework with updated

– Modality Procedure Step in Progress– Modality Images Stored– Imported Procedure Step in Progress– Imported Images Stored

…

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Transactions

Updated Transactions• Modality Worklist Provided -- Additional description of importing

hardcopy

• Broad Worklist Query (Open issue)

• Modality Performed Procedure Step In Progress to include the importing of hardcopy data.

• Modified Performed Procedure Step Completed/Discontinued to include Import

• Modality Images Stored to include the importing of hardcopy data.

New Transactions• Import Performed Procedure Step In Progress to discuss the specific

requirements for Imported DICOM Composite Objects on how data needs to be coherced in some cases and maintained from the original DICOM Composite Objects in other cases.

• Import Images Stored to discuss the specific requirements for Imported DICOM Composite Objects.

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Use Case #1: Patient Known, Scheduled Order

•An institution contracts for a study to be performed externally outside the institution. The studies are ordered and performed externally. The images are read either inside or outside the institution. The images and results shall be placed in the patient’s EHR.  •An example of this might be an imaging study done at a commercial imaging center because the local medical center does not have the necessary equipment. Sometimes the institution only wants the images are on the CD and the institution wants its radiologists to interpret them. Other times the institution has the outside radiologists do the reading, and the CD comes with both the images and the corresponding reports.

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Use Case #1 Workflow

Patient Known,

Order Placed

2

3

4

5

1. DICOM Modality Worklist

2.2. DICOM Imported PPSDICOM Imported PPS

3.3. DICOM DICOM Imported Imported StoreStore

4. DICOM Storage Commitment

5. DICOM Query/Retrieve

1

Report

Image Archive

Patient Data

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Use Case #2: Patient Known, Unscheduled Order

The patient is seen at a facility outside the RHIO and has examinations performed that were not ordered by RHIO practitioners. The patient presents to the provider with a CD that includes evidence documents. A RHIO practitioner determines that the results of these examinations are important for proper patient care and that the images and report need to be added to the EHR. A ‘historical’ order is placed to create the study on the HIS/RIS and the data is added to the EHR.

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Use Case #2 Workflow

2

3

4

5

1. DICOM Modality Worklist

2.2. DICOM Imported PPSDICOM Imported PPS

3.3. DICOM DICOM Imported Imported StoreStore

4. DICOM Storage Committment

5. DICOM Query/Retrieve

1

Portable Media Importer

Report

Image Archive

Patient Known,

‘Historical’ Order Placed

Patient Data

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Use Case #3: Patient not Known

Patient information is delivered to a provider in advance of admission. The patient is not known to the RHIO. The provider is made aware that the patient information contained on the CD is not sufficient to register the patient. The provider wishes to view and interpret the images immediately and then later, add the patient and procedure information into the record. The provider places the data into a ‘temporary’ queue and puts the information ‘on the shelf’ until additional information has been made available.

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Use Case #3 Workflow

2

3

4

5

1. DICOM Modality Worklist

2.2. DICOM Imported PPSDICOM Imported PPS

3.3. DICOM DICOM Imported Imported StoreStore

4. DICOM Storage Commitment

5. DICOM Query/Retrieve

1

Portable Media Importer

Report

Image ArchivePatient Not Known,

New Order Placed

Patient Data

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Use Case #4: Referral

A patient is referred to a institution’s provider. The patient’s data arrives from the original organization via CD, paper and film. If the patient is not known, the provider must register the patient as a “Jane Doe”. Once the patient is registered, then an order is placed.

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Use Case #5: Film Scanning

An institution has a film scanning policy that imports a patient’s films on an as needed basis. Prior to a patient visit, a patient’s data is scanned into DICOM format. This data is made available for a provider to review and compare with incoming data.

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In Scope / Out of Scope

Below are the results of the group’s “what’s inscope of this work” discussion

Feature In/Out

Broad Worklist Query In

Append In

Film, Paper Import into DICOM In

Exception Handling In

additional Security consideration Out

Reports Out

Non-DICOM formats Out

Note: list functionality especially at borders of what is included/excluded – i.e., included features that could reasonably be descoped by the Technical Committee, or excluded features that could be included

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Open Issues

•What’s my Name•Performed Procedure Step Manager•Modification to Volume II Appendix A•Reports•DICOM CP-526•Coordination with Cardio