IHE Radiology Workflow: Adaptation to Cardiology Harry Solomon.

IHE Radiology Workflow:IHE Radiology Workflow:Adaptation to CardiologyAdaptation to Cardiology

Harry SolomonHarry Solomon

March, 2004 IHE Cardiology Technical Committee2

Access toRadiology

Information

Consistentaccess to

images andreports

IHE Radiology Integration ProfilesIHE Radiology Integration Profiles

Patient Information

Reconciliation

Unknown patients and unscheduled

orders

ConsistentPresentation of

Images

Hardcopy and softcopy

grayscale and presentation state

Presentation ofGrouped Procedures

Subset a single acquisition

Key ImageNotes

Exchange flaggingsignificant images

Simple Image andNumeric Reports

Exchange simplereports with image

links and, optionally,measurements

Scheduled WorkflowAdmit, order, schedule, acquire images, notify of completed steps


Integration Profiles to be Adapted Integration Profiles to be Adapted for Cardiology Year 1for Cardiology Year 1

Patient Information

Reconciliation

Unknown patients and unscheduled

orders

Scheduled WorkflowAdmit, order, schedule, acquire images, notify of completed steps

4 IHE Cardiology Technical CommitteeMarch, 2004

A Review of A Review of “Normal” Workflow Processes“Normal” Workflow Processes

• Topics:Topics:– HL7 Actors and Transactions in IHE HL7 Actors and Transactions in IHE – DICOM Actors and TransactionsDICOM Actors and Transactions– Normal Workflow ProcessesNormal Workflow Processes– Patient and Order Update ProcessesPatient and Order Update Processes– Patient Information ReconciliationPatient Information Reconciliation– SummarySummary


1: Pt registration 12: Pt Update

Pt registration: 1 Pt Update: 12 2: Placer Order Management

3: Filler Order Management

ADT

4: Procedure Scheduled 12: Patient Update 13: Procedure Update

Image Manager

Order Placer Order Filler

HL7 Actors in WorkflowHL7 Actors in Workflow

HL7 Actors:HL7 Actors:• ADT/Patient ADT/Patient

RegistrationRegistration• Order PlacerOrder Placer• DSS / Order FillerDSS / Order Filler• Image ManagerImage Manager





ADT


Image Manager


ADT ActorADT Actor


ADT ActorADT Actor

• 4.1 - Patient Registration transaction4.1 - Patient Registration transaction– SendSend

• Admit: A01 (In Patient), A04 (Out Patient), A05 (Pre-Admit: A01 (In Patient), A04 (Out Patient), A05 (Pre-Admission)Admission)

• Cancel: A11 (Cancel Admit), A38 (Cancel Preadmit)Cancel: A11 (Cancel Admit), A38 (Cancel Preadmit)


ADT Actor (cont.)ADT Actor (cont.)

• 4.12 - ADT Patient Update transaction4.12 - ADT Patient Update transaction– SendSend

• Transfer: A02 (Patient Transfer)Transfer: A02 (Patient Transfer)• Update Patient Class: A03 (Discharge), A06(Outpatient Update Patient Class: A03 (Discharge), A06(Outpatient

becomes Inpatient), A07 (Inpatient becomes Outpatient)becomes Inpatient), A07 (Inpatient becomes Outpatient)• Update Patient Information: A08 (Update)Update Patient Information: A08 (Update)• Merge Patients: A40 (Merge)Merge Patients: A40 (Merge)• Cancel: A12 (Cancel Transfer), A13 (Cancel Discharge)Cancel: A12 (Cancel Transfer), A13 (Cancel Discharge)





ADT


Image Manager


Order Placer ActorOrder Placer Actor


Order Placer ActorOrder Placer Actor

• 4.2 - Placer Order Management transaction4.2 - Placer Order Management transaction– SendSend

• New Order: ORM/NW (New Order)New Order: ORM/NW (New Order)• Cancel: ORM/CA (Cancel Order), ORM/DC (Discontinue)Cancel: ORM/CA (Cancel Order), ORM/DC (Discontinue)


Order Placer Actor (cont.)Order Placer Actor (cont.)• 4.1 - Patient Registration transaction4.1 - Patient Registration transaction

– ReceiveReceive• A01 (In Patient), A04 (Out Patient), A05 (Pre-Admission), A11 (Cancel A01 (In Patient), A04 (Out Patient), A05 (Pre-Admission), A11 (Cancel

Admit), A38 (Cancel Preadmit)Admit), A38 (Cancel Preadmit)

• 4.12 - Patient Update transaction4.12 - Patient Update transaction – ReceiveReceive

• A02 (Patient Transfer), A03 (Discharge), A06(Outpatient becomes A02 (Patient Transfer), A03 (Discharge), A06(Outpatient becomes Inpatient), A07 (Inpatient becomes Outpatient), A08 (Update), A12 Inpatient), A07 (Inpatient becomes Outpatient), A08 (Update), A12 (Cancel Transfer), A13 (Cancel Discharge), A40 (Merge)(Cancel Transfer), A13 (Cancel Discharge), A40 (Merge)

• 4.3 - Filler Order Management transaction4.3 - Filler Order Management transaction – ReceiveReceive

• ORM/SN (New Order), ORM/SC (Status Update), ORM/OC (Cancel ORM/SN (New Order), ORM/SC (Status Update), ORM/OC (Cancel Order)Order)





ADT


Image Manager


DSS / Order Filler ActorDSS / Order Filler Actor


Department System Department System Scheduler/Order Filler ActorScheduler/Order Filler Actor

• 4.3 - Placer Filler Management transaction4.3 - Placer Filler Management transaction– SendSend

• New Order: ORM/SN (New Order)New Order: ORM/SN (New Order)

• Order Status: ORM/SC (Status Change)Order Status: ORM/SC (Status Change)

• Cancel: ORM/OC (Cancel Order)Cancel: ORM/OC (Cancel Order)

• 4.4 - Procedure Scheduled transaction4.4 - Procedure Scheduled transaction– SendSend

• ORM (procedure scheduled)ORM (procedure scheduled)

• 4.13 - Procedure Updated transaction4.13 - Procedure Updated transaction– SendSend

• ORM (procedure updated)ORM (procedure updated)


DSS/Order Filler Actor (Cont.)DSS/Order Filler Actor (Cont.)

• 4.1 - Patient Registration transaction4.1 - Patient Registration transaction – ReceiveReceive

• A01 (In Patient), A04 (Out Patient), A05 (Pre-Admission), A11 (Cancel A01 (In Patient), A04 (Out Patient), A05 (Pre-Admission), A11 (Cancel Admit), A38 (Cancel Preadmit)Admit), A38 (Cancel Preadmit)

• 4.12 - Patient Update transaction4.12 - Patient Update transaction – ReceiveReceive

• A02 (Patient Transfer), A03 (Discharge), A06(Outpatient becomes A02 (Patient Transfer), A03 (Discharge), A06(Outpatient becomes Inpatient), A07 (Inpatient becomes Outpatient), A08 (Update), A12 Inpatient), A07 (Inpatient becomes Outpatient), A08 (Update), A12 (Cancel Transfer), A13 (Cancel Discharge), A40 (Merge)(Cancel Transfer), A13 (Cancel Discharge), A40 (Merge)

• 4.2 - Placer Order Management transaction4.2 - Placer Order Management transaction – ReceiveReceive

• ORM/NW (New Order), ORM/CA (Cancel Order), ORM/DC (Discontinue)ORM/NW (New Order), ORM/CA (Cancel Order), ORM/DC (Discontinue)


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]

Administrative Normal Administrative Normal Process FlowProcess Flow


Image Manager


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

Procedure PerformanceProcedure PerformanceNormal Process FlowNormal Process Flow


ADT Order Placer

Patient

Image Manager




Register/ Admit Patient

Create Order

Modify Patient

Patient Update [12]

Registration [1]

Patient

Update [12]

Patient UpdatePatient UpdateBefore Order Entry Before Order Entry


ADT Order Placer

Image Manager




Admit/ Register Patient

Create Order

Modify Patient

Patient

Registration [1]

Patient

Update [12]

Patient Update [12]

Patient UpdatePatient UpdateAfter Order Entry After Order Entry



ADT Order Placer

Patient Registration [1]

Image Manager



Department System Scheduler/ Order

Filler


Register/Admit Patient

Create Order

Schedule Procedure and/or Assign Protocol

Patient Update [12]

Modify Patient Patient

Update [12]

Patient UpdatePatient UpdateAfter Procedure SchedulingAfter Procedure Scheduling


Order ReplacementOrder ReplacementBy the Order PlacerBy the Order Placer


ADT Order Placer

Image Manager


Placer Order Mgmt - Cancel [2]


Procedure Update [13]

Cancel Order



Create Order

Placer Order Mgmt - New [2]


Order ReplacementOrder ReplacementBy the DSS/Order FillerBy the DSS/Order Filler


Procedure Update [13]


Filler Order Mgmt - Cancel [3]


Order Cancelled

Filler Order Mgmt – New [3]

Create Order

ADT Order Placer

Image Manager




Image Information ManagementImage Information Management• Defined to facilitate communication between Defined to facilitate communication between

IS, PACS and Modality productsIS, PACS and Modality products

• DICOM services in use are:DICOM services in use are:– Modality Worklist Management (MWL)Modality Worklist Management (MWL)

– Modality Performed Procedure Step (PPS)Modality Performed Procedure Step (PPS)

– StorageStorage

– Storage CommitmentStorage Commitment

– Query/RetrieveQuery/Retrieve

March, 2004 IHE Cardiology Technical Committee

IHE Scheduled Workflow ConceptsIHE Scheduled Workflow Concepts

PROCEDURE STEPPROCEDURE STEP : : The smallest unit of work in the workflow:The smallest unit of work in the workflow:

ScheduledScheduled Procedure Step: Procedure Step: ‘A unit of work ‘A unit of work to do’to do’ PerformedPerformed

Procedure Step: Procedure Step: ‘A unit of work ‘A unit of work donedone’’

IHE has addressed this and other workflow processes by selectingIHE has addressed this and other workflow processes by selecting

three UNAMBIGUOUS three UNAMBIGUOUS HL7/DICOM TERMS : TERMS :

ORDERORDER : : A request for healthcare A request for healthcare

serviceservice

REQUESTED PROCEDUREREQUESTED PROCEDURE : : Units of work resulting in Units of work resulting in one Reportone Reportwithwith associated codified, billable acts associated codified, billable acts


IHE Radiology Addressed this IHE Radiology Addressed this ProblemProblem

This 3 level This 3 level wworkflow orkflow sstructuring tructuring cconceptoncept is is useruser orientedoriented::

OORDER:RDER:A request for A request for imagingimaging service service

(Accession Number)(Accession Number)

REQUESTED PROCEDUREREQUESTED PROCEDURE : : Units of work resulting in one Units of work resulting in one ReportReport

with with associated codified, billable actsassociated codified, billable acts(Requested Procedure ID)(Requested Procedure ID)

PROCEDURE STEPPROCEDURE STEP : :The smallest unit of workThe smallest unit of work

in the workflowin the workflow(modality worklist entry)(modality worklist entry)

CLINICIANCLINICIANOR REFERING DOC:OR REFERING DOC:

The Imaging Dept CustomerThe Imaging Dept Customer

RADIOLOGISTRADIOLOGIST : : In Charge of producingIn Charge of producing

thethe ReportReport

TECHNOLOGISTTECHNOLOGIST(and RADIOLOGIST)(and RADIOLOGIST)

In charge of acquiring In charge of acquiring images, etc.images, etc.


Issues in Adaptation to CardiologyIssues in Adaptation to Cardiology

• Ordering clinician is often also Ordering clinician is often also performing clinician performing clinician

• Multi-modality, with same personnel Multi-modality, with same personnel operating all modalitiesoperating all modalities

• Mandatory pre-procedure and post-Mandatory pre-procedure and post-procedure activitiesprocedure activities


Normal WorkflowNormal WorkflowTypical workflow: Typical workflow: One OrderOne Order – – One ProcedureOne Procedure – – One ReportOne Report

ORDERA request for RadiologicService

RequestedProcedure

Radiology Department

One or more series of images

ReportSet of

Codifiable,Billable,

ActsAcquisition Modality


AcquisitionModality

AcquisitionModality

Multiple Modality StepsMultiple Modality Steps

ORDERA request for RadiologicService

Radiology Department

Set of Codifiable,

Billable, ActsOne or more series of images

PerformedProcedure

Step P1

ScheduledProcedure

Step B

RequestedProcedure

1

ScheduledProcedure

Step A

Report

One or more series of images

PerformedProcedure

Step P1

DICOMModality Worklist

DICOMModality Worklist


Actors and TransactionsActors and Transactions

DepartmentSystem Scheduler

/ Order Filler ImageManager

PerformedProcedure Step

Manager

AcquisitionModality

Modality WorklistProvided

5

Storage

Commitment

10

Modality Images Stored

8

Image Display

ImageArchive

Mod. ProcedureStep In-Progress

/Completed6 7

Modality/Creator.Procedure Step

In-Progress/Completed.

6

20

7

21



6

20

7

21

Retrieve Images

16

Query Images

14


Modality WorklistModality Worklist


MWL Actors and TransactionMWL Actors and Transaction




Manager

AcquisitionModality

Modality WorklistProvided

5

Image Display

ImageArchive


Modality WorklistModality Worklist• MWL enables modality integration with MWL enables modality integration with

information system’s managed datainformation system’s managed data• Prepare imaging procedure by including Prepare imaging procedure by including

patient, scheduling and medical datapatient, scheduling and medical data(i.e. Patient Name/ID, procedure date/time, (i.e. Patient Name/ID, procedure date/time, procedure codes, Accession Number, procedure codes, Accession Number, Requested Procedure ID.…)Requested Procedure ID.…)

• Avoids typing errors by fixing data entry Avoids typing errors by fixing data entry problems at the source of image creationproblems at the source of image creation

• MWL is a “one way trip” (i.e. IS to Modality)MWL is a “one way trip” (i.e. IS to Modality)

Not only to include HIS/RIS Data in DICOM Images, Not only to include HIS/RIS Data in DICOM Images, but to enable the workflow: “acquisition work to do”but to enable the workflow: “acquisition work to do”

Not only to include HIS/RIS Data in DICOM Images, Not only to include HIS/RIS Data in DICOM Images, but to enable the workflow: “acquisition work to do”but to enable the workflow: “acquisition work to do”


C-FIND-RQ (with matching and return keys)C-FIND-RQ (with matching and return keys)

C-FIND-RSP (one per match plus final response)C-FIND-RSP (one per match plus final response)Modality DSS/

Order Filler

Modality WorklistModality Worklist

• Explicit definition of required matching and return Explicit definition of required matching and return keys for the DSS and Modality. keys for the DSS and Modality. – what the modality may use to filter the response/what the what the modality may use to filter the response/what the

DSS has to match onDSS has to match on– what the modality can ask DSS to return (for display in what the modality can ask DSS to return (for display in

MWL)/what the DSS shall be able to returnMWL)/what the DSS shall be able to return


Performed Procedure StepPerformed Procedure Step


PPS Actors and TransactionsPPS Actors and Transactions




Manager

AcquisitionModality

Image Display

ImageArchive

Mod. ProcedureStep In-Progress

/Completed6 7



6

20

7

21



6

20

7

21


Performed Procedure StepPerformed Procedure Step• Applies to ModalityApplies to Modality• Convey details about procedure step(s) performedConvey details about procedure step(s) performed• Conveys detailed statuses such as “in progress”, Conveys detailed statuses such as “in progress”,

“completed” and “discontinued”“completed” and “discontinued”• Provides “return trip” feedback such as:Provides “return trip” feedback such as:

– Scheduled information obtained via MWLScheduled information obtained via MWL– What, when, and how was the procedure performedWhat, when, and how was the procedure performed– Accession Number, Patient Name/ID, procedure step codesAccession Number, Patient Name/ID, procedure step codes– List of images acquired/created, Study Instance UID ….List of images acquired/created, Study Instance UID ….

Not only tells that the performed step is complete, Not only tells that the performed step is complete, But closes the workflow: “acquisition/creation work done”But closes the workflow: “acquisition/creation work done”

Not only tells that the performed step is complete, Not only tells that the performed step is complete, But closes the workflow: “acquisition/creation work done”But closes the workflow: “acquisition/creation work done”

Images StoredImages Stored


Images Stored Actors and TransactionsImages Stored Actors and Transactions




Manager

AcquisitionModality

Modality Images Stored

8

Image Display

ImageArchive


Images StoredImages Stored

• Applies to Modality and Image CreatorApplies to Modality and Image Creator• Scheduled Procedure Step and Requested Scheduled Procedure Step and Requested

Procedure information is recorded.Procedure information is recorded.

C-STORE (Images Stored)C-STORE (Images Stored)Modality orImage Creator

Image Archive


Storage CommitmentStorage Commitment


Storage Commitment Actors and TransactionsStorage Commitment Actors and Transactions




Manager

AcquisitionModality

Storage

Commitment

10

Image Display

ImageArchive


Storage CommitmentStorage Commitment

• Modalities obtain explicit agreement from a Modalities obtain explicit agreement from a storage device (i.e. archive, etc.) that images storage device (i.e. archive, etc.) that images (and other objects) will be reliably stored(and other objects) will be reliably stored

• The duration of storage is defined by the The duration of storage is defined by the storage device productstorage device product

• Facilitates automated or simplified deletion of Facilitates automated or simplified deletion of images on modalities, workstations, etc.images on modalities, workstations, etc.

Avoids accidental deletion of images on Avoids accidental deletion of images on modalities and workstationsmodalities and workstations

Avoids accidental deletion of images on Avoids accidental deletion of images on modalities and workstationsmodalities and workstations


C-STORE operations ….C-STORE operations ….

N-ACTION - (list of referenced image UIDs)N-ACTION - (list of referenced image UIDs)

N-EVENT-REPORT - (success or failure)N-EVENT-REPORT - (success or failure)

Image Manager

Storage Commit. - Push ModelStorage Commit. - Push Model

• Images (or objects) are pushed to storage deviceImages (or objects) are pushed to storage device• N-ACTION provides a list of UIDs for objects to be N-ACTION provides a list of UIDs for objects to be

reliably stored (may be different AE than storage)reliably stored (may be different AE than storage)• N-EVENT-REPORT confirmation from Storage to N-EVENT-REPORT confirmation from Storage to

ModalityModality• Implementations must design for transactions being Implementations must design for transactions being

on multiple associationson multiple associations• When N-EVENT-REPORT is sent by Storage Device When N-EVENT-REPORT is sent by Storage Device

is product dependent and may be hours after N-is product dependent and may be hours after N-ACTIONACTION

Modality orImage Creator


Image Query/RetrieveImage Query/Retrieve





Manager

AcquisitionModality

Image Display

ImageArchive

Retrieve Images

16

Query Images

14

Query/Retrieve Actors and TransactionQuery/Retrieve Actors and Transaction


Query Retrieve of ImagesQuery Retrieve of Images

• Defines Matching keys for response filtering Defines Matching keys for response filtering by Image Archiveby Image Archive

• Defines Return keys to be requested by Defines Return keys to be requested by Image DisplayImage Display

• Defines Returned attributes by Image ArchiveDefines Returned attributes by Image Archivein query responsesin query responses

• Defines Returned attributes required to be Defines Returned attributes required to be displayed on Image Displaydisplayed on Image Display

C-FIND-RQ (with matching and return keys)C-FIND-RQ (with matching and return keys)

C-FIND-RSP (matches with return keys)C-FIND-RSP (matches with return keys)ImageDisplay

Image Archive


IHE Generic IHE Generic Keys for Keys for Query Query

Retrieve of:Retrieve of:- Images- Images

- SR- SR

Query Keys Matching Query Keys ReturnAttributes Name Tag

SCU SCP SCU SCP

Study Level

Study Date (0008,0020) R+ R R+ R

Study Time (0008,0030) R+ R R+ R

Accession Number (0008,0050) R+ R R+ R

Patient Name (0010,0010) R+ R R+ R

Patient ID (0010,0020) R+ R R+ R

Study ID (0020,0010) R+ R R+ R

Study Instance UID (0020,000D) R+ R O R

Modalities in Study (0008,0061) R+ R+ R+ R+

Referring Physician’s Name (0008,0090) R+ R+ R+ R+

Patient’s Birth Date (0010,0030) O O R+ R+

Patient’s Sex (0010,0040) O O R+ R+

Number of Study Related Series (0020,1206) N/A N/A O R+

Number of Study Related Instances (0020,1208) N/A N/A O R+

Series Level

Modality (0008,0060) R+ R R+ R

Series Number (0020,0011) R+ R R+ R

Series Instance UID (0020,000E) R+ R O R

Number of Series Related Instances (0020,1209) N/A N/A O R

Request Attribute Sequence (0040,0275) R+ R+ R+ R+

>Requested Procedure ID (0040,1001) R+ R+ R+ R+

>Scheduled Procedure Step ID (0040,0009) R+ R+ R+ R+

Performed Procedure Step Start Date (0040,0244) R + R+ R+ R+

Performed Procedure Step Start Time (0040,0245) R + R+ R+ R+

Composite Object Instance Level

Instance Number (0020,0013) R R O R

SOP Instance UID (0008,0018) R+ R O R

SOP Class UID (0008,0016) O R O R+

R = Required by DICOM

R+ = IHE Requirement to be displayed or entered (SCU), to be returned(SCP)


Image Specific Query Matching Image Specific Query Matching and Return Keysand Return Keys

Query Keys Matching Query Keys ReturnAttribute Name Tag

SCU SCP SCU SCP

Image Specific Level

Rows (0028,0010) O O O R+

Columns (0028,0011) O O O R+

Bits Allocated (0028,0100) O O O R+

Number of Frames (0028,0008) O O O R+

Patient Information Patient Information ReconciliationReconciliation


““Trauma Case”Trauma Case”• Emergency Department PatientEmergency Department Patient

• No patient identification:No patient identification:– Patient unconsciousPatient unconscious– Life-threatening situationLife-threatening situation– Urgent procedure - no time for registrationUrgent procedure - no time for registration

• No ordering and/or scheduling of a No ordering and/or scheduling of a procedureprocedure


““Real-World” ScenarioReal-World” Scenario• The patient is delivered to the The patient is delivered to the

department where it is assigned a department where it is assigned a temporary departmental Patient ID temporary departmental Patient ID and/or name.and/or name.

• The order is then entered by the The order is then entered by the DSS/Order Filler and with this Patient ID DSS/Order Filler and with this Patient ID and/or name, the procedure is and/or name, the procedure is performed on the Acquisition Modality.performed on the Acquisition Modality.


““Real-World” ScenarioReal-World” Scenario• Image Manager obtains departmental Image Manager obtains departmental

Patient ID from the images or through Patient ID from the images or through MPPS.MPPS.

• DSS/Order Filler sends Order message DSS/Order Filler sends Order message to the Order Filler.to the Order Filler.

• ADT does not know about departmental ADT does not know about departmental Patient IDPatient ID


““Real-World” ScenarioReal-World” Scenario• When ADT eventually registers or reconciles When ADT eventually registers or reconciles

patient information, it sends messages to all patient information, it sends messages to all systems.systems.

• EACH system has to perform reconciliation EACH system has to perform reconciliation of departmental patient record to the one of departmental patient record to the one provided by ADT.provided by ADT.

• Multiple points of reconciliation!Multiple points of reconciliation!

• Even worse when more than one departmentEven worse when more than one department


Current problems Current problems

• Unidentified patient’s information must Unidentified patient’s information must be properly entered into all systems, be properly entered into all systems, both enterprise-wide and departmentalboth enterprise-wide and departmental

• High possibility of error while entering High possibility of error while entering patient information into the systems by patient information into the systems by handhand

• High possibility of mismatch of local High possibility of mismatch of local information with that provided by ADTinformation with that provided by ADT


Current problems - cont’dCurrent problems - cont’d

• Each system will have to perform Each system will have to perform manual merge of initial patient record manual merge of initial patient record into one supplied by ADTinto one supplied by ADT

• Multiple points of reconciliation - high Multiple points of reconciliation - high risk possibility of data being risk possibility of data being unsynchronizedunsynchronized

• High possibility of mismatch of local High possibility of mismatch of local information with that provided by ADTinformation with that provided by ADT


Unidentified Patient Use CasesUnidentified Patient Use Cases• Local policy calls for ADT to pre-register Local policy calls for ADT to pre-register

ER patients (“John Doe”, “Jane Doe”):ER patients (“John Doe”, “Jane Doe”):– Case 1: Unidentified Patient registered at Case 1: Unidentified Patient registered at

ADT and order is placed at Order Placer.ADT and order is placed at Order Placer.– Case 2: Unidentified Patient registered at Case 2: Unidentified Patient registered at

ADT and order is placed at DSS/Order ADT and order is placed at DSS/Order Filler.Filler.

– Case 3: Unidentified Patient registered at Case 3: Unidentified Patient registered at ADT but acquisition completed at Modality ADT but acquisition completed at Modality prior to order.prior to order.


Unidentified Patient Use CasesUnidentified Patient Use Cases• Local policy allows departments to Local policy allows departments to

register ER patients with Departmental register ER patients with Departmental IDs:IDs:– Case 4: Unidentified Patient assigned Case 4: Unidentified Patient assigned

temporary Departmental ID and scheduled temporary Departmental ID and scheduled at DSS/Order Filler.at DSS/Order Filler.

– Case 5: Image Acquisition completed prior Case 5: Image Acquisition completed prior to assigning temporary Departmental ID or to assigning temporary Departmental ID or Order (Patient ID entered at the Modality).Order (Patient ID entered at the Modality).


Unidentified Patient - Case 1Unidentified Patient - Case 1ADT Order

Placer

ImageManager Modality

MWL Provided [5]

Department SystemDatabase/Scheduler/

Order Filler

Placer Order Mgmt

NewOrder [2]

ProcedureScheduled [4]

Patient Reconciliation

J.Doe -> J.Smith

PatientUpdate [12]

Schedule Procedure

ImagesAcquired

Modality ProcedureStep Completed [7]


Register J.Doe

Patient

Update [12]

Patient

Registration [1]


Patient Name/ID Path - Case 1Patient Name/ID Path - Case 1Transaction Patient ID Protocol & Field Prior Patient ID (HL7)

Register J.Doe (Temp_123)

A01 (ADT -> OP) Temp_123^^ÂDT_Issuer HL7 (PID-3) N/A

A01 (ADT -> OF) Temp_123^^ÂDT_Issuer HL7 (PID-3) N/A

ORM (OP->OF) Temp_123^^ÂDT_Issuer HL7 (PID-3) N/A

ORM (OF->IM) Temp_123^^ÂDT_Issuer HL7 (PID-3) N/A

DICOM MWL

(OF -> Modality)

Temp_123 DICOM (0010,0020) N/A

PPS (Modality ->PPSM)

Temp_123 DICOM (0010,0020) N/A

PPS (PPSM -> IM) Temp_123 DICOM (0010,0020) N/A

PPS (PPSM -> OF) Temp_123 DICOM (0010,0020) N/A

ADT reconciles J.Doe(Temp_123) ->J.Smith(456)

A40 (ADT -> OF) 456^^ÂDT_Issuer HL7 (PID-3) 123^^ÂDT_Issuer

A40 (OF->IM) 456^^ÂDT_Issuer HL7 (PID-3) 123^^ÂDT_Issuer

A40 (ADT -> OP) 456^^ÂDT_Issuer HL7 (PID-3) 123^^ÂDT_Issuer



Placer


MWL Provided [5]


Order Filler

Filler Order Mgmt

New Order[3]



J.Doe -> J.Smith

PatientUpdate [12]

Schedule Procedure

ImagesAcquired



Register J.Doe

Patient

Update [12]

Patient

Registration [1]






ORM (OF->OP) Temp_123^^^ADT_Issuer HL7 (PID-3) N/A

ORR (OP->OF) Temp_123^^^ADT_Issuer HL7 (PID-3) N/A


DICOM MWL

(OF -> Modality)

Temp_123 DICOM (0010,0020) N/A


Temp_123 DICOM (0010,0020) N/A



ADT reconcilse J.Doe(Temp_123) ->J.Smith(456)






Placer



Order Filler

Filler Order Mgmt

New Order [3]



J.Doe -> J.Smith

PatientUpdate [12]

Schedule Procedure

ImagesAcquired



Register J.Doe

Patient

Update [12]

Patient

Registration [1]






Temp_123 manually entered at the Modality


Temp_123 DICOM (0010,0020) N/A


IM recognizes unscheduled MPPS and assumes assigning authority “ADT_Issuer”


OF recognizes unscheduled MPPS with valid Patient ID and assumes assigning authority “ADT_Issuer”

ORM (OF->OP) Temp_123^^^ADT_Issuer HL7 (PID-3) N/A

ORR (OP->OF) Temp_123^^^ADT_Issuer HL7 (PID-3) N/A


ADT reconciles J.Doe(Temp_123) ->J.Smith(456)






Placer


MWL Provided [5]


Order Filler

Filler Order Mgmt

New Order [3]



J.Doe -> J.Smith

PatientUpdate [12]

Schedule Procedure for J.Doe

ImagesAcquired



Register J.Smith

Patient

Registration [1]



OF creates J.Doe (Dept_123)

ORM (OF->IM) Dept_123^^ÂDT_Issuer HL7 (PID-3) N/A

DICOM MWL(OF->Modality)

Dept_123 DICOM (0010,0020)


Dept_123 DICOM (0010,0020) N/A

PPS (PPSM -> IM) Dept_123 DICOM (0010,0020) N/A

IM recognizes unscheduled MPPS and assumes assigning authority “OF_Issuer”

PPS (PPSM -> OF) Dept_123 DICOM (0010,0020) N/A

OF recognizes unscheduled MPPS with valid Patient ID and assumes assigning authority “OF_Issuer”

ADT registers J.Smith (456)

A01 (ADT -> OP) Dept_123^^ÂDT_Issuer HL7 (PID-3) N/A

A01 (ADT -> OF) Dept_123^^ÂDT_Issuer HL7 (PID-3) N/A

OF reconciles J.Doe(Dept_123) ->J.Smith(456)

A40 (OF->IM) 456^^ÂDT_Issuer HL7 (PID-3) Dept_123^^ÔF_Issuer

ORM (OF->OP) 456^^ÂDT_Issuer HL7 (PID-3) N/A

ORR (OP->OF) 456^^ÂDT_Issuer HL7 (PID-3) N/A

ORM (OF->IM) 456^^ÂDT_Issuer HL7 (PID-3) N/A



Placer



Order Filler

Filler Order Mgmt

New Order [3]ProcedureScheduled [4]


J.Doe -> J.Smith

PatientUpdate [12]

Schedule Procedure

ImagesAcquired for J.Doe



Register J.Smith

Patient

Registration [1]



Modality performs procedure J.Doe (Dept_123)


Dept_123 DICOM (0010,0020) N/A

PPS (PPSM -> IM) Dept_123 DICOM (0010,0020) N/A

IM recognizes unscheduled MPPS and assumes configured assigning authority [“OF_Issuer”]

PPS (PPSM -> OF) Dept_123 DICOM (0010,0020) N/A

OF recognizes unscheduled MPPS with invalid Patient ID and assumes assigning authority [“OF_Issuer”]

ADT registers J.Smith (456)

A01 (ADT -> OP) Dept_123^^ÂDT_Issuer HL7 (PID-3) N/A

A01 (ADT -> OF) Dept_123^^ÂDT_Issuer HL7 (PID-3) N/A

OF reconciles J.Doe(Dept_123) ->J.Smith(456)

A40 (OF->IM) 456^^ÂDT_Issuer HL7 (PID-3) Dept_123^^ÔF_Issuer

ORM (OF->OP) 456^^ÂDT_Issuer HL7 (PID-3) N/A

ORR (OP->OF) 456^^ÂDT_Issuer HL7 (PID-3) N/A

ORM (OF->IM) 456^^ÂDT_Issuer HL7 (PID-3) N/A


System RequirementsSystem Requirements• Participating systems - ADT, Order Participating systems - ADT, Order

Placer, Order Filler and Image Manager Placer, Order Filler and Image Manager communicate updates via HL7communicate updates via HL7

• All systems must support ADT^A40:All systems must support ADT^A40:– PID-3 field for new Patient IDPID-3 field for new Patient ID– MRG-1 field for old Patient IDMRG-1 field for old Patient ID

• Data Type for Patient ID must be CXData Type for Patient ID must be CX

• Assigning Authority must be included Assigning Authority must be included with Patient IDwith Patient ID


System RequirementsSystem Requirements• Order Filler and Image Manager may Order Filler and Image Manager may

encounter Patient ID without assigning encounter Patient ID without assigning authority conveyed in MPPS via DICOMauthority conveyed in MPPS via DICOM

• OF and IM will assume assigning OF and IM will assume assigning authority (configurable, but the same)authority (configurable, but the same)

• OF and IM shall be able to recognize OF and IM shall be able to recognize valid Patient IDvalid Patient ID


Policy RequirementsPolicy Requirements• Institution shall choose whether pre-Institution shall choose whether pre-

registration of ER patients happens at registration of ER patients happens at the ADT levelthe ADT level

• OF and IM shall be configured to the OF and IM shall be configured to the same assigning authoritysame assigning authority

• Order Filler shall be able to distinguish Order Filler shall be able to distinguish valid Patient ID from invalid onevalid Patient ID from invalid one

• In Cases 4 and 5, OF must reconcile In Cases 4 and 5, OF must reconcile patient info before orderingpatient info before ordering

IHE Radiology Workflow: Adaptation to Cardiology Harry Solomon.

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Transcript of IHE Radiology Workflow: Adaptation to Cardiology Harry Solomon.