IHE Workshop – June 2006What IHE Delivers 1 Kevin ODonnell Toshiba Medical Systems Scheduled...
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1 IHE Workshop – June 2006 What IHE Delivers Kevin O’Donnell Kevin O’Donnell Toshiba Medical Systems Toshiba Medical Systems Scheduled Workflow: Scheduled Workflow: The First Profile The First Profile
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Transcript of IHE Workshop – June 2006What IHE Delivers 1 Kevin ODonnell Toshiba Medical Systems Scheduled...
1IHE Workshop – June 2006 What IHE Delivers
Kevin O’DonnellKevin O’Donnell
Toshiba Medical SystemsToshiba Medical Systems
Scheduled Workflow:Scheduled Workflow:The First ProfileThe First Profile
2IHE Workshop – June 2006IHE Workshop – June 2006
Scheduled WorkflowScheduled WorkflowScopeScope
Genesis 1: In the beginning, …
• [ or better yet ]
Genesis 11: Tower of Babel “and there confound their language, that they may
not understand one another's speech. “
3IHE Workshop – June 2006IHE Workshop – June 2006
Scheduled WorkflowScheduled WorkflowScopeScope
Backbone of IHE Radiology
Integrates Registration, Scheduling, Acquisition Workflow and Image Content
Bridges HL7 and DICOM Spaces
4IHE Workshop – June 2006IHE Workshop – June 2006
imagesstored
patientinformation
RIS
examination orders
imagesretrieved
HIS
PACS
procedurescheduled
Prefetch any relevantprior studies
modalityworklist
report
report
Scheduled Workflow: Use CaseScheduled Workflow: Use Case
Registration
Orders Placed
Orders Filled
Film
FilmFolder
Image Manager& Archive
FilmLightbox
report ReportRepository
DiagnosticWorkstation
Modality
acquisitionacquisitionin-progressin-progressacquisitioncompleted
acquisitioncompleted
imagesprinted
AcquisitionModality
5IHE Workshop – June 2006IHE Workshop – June 2006
Scheduled WorkflowScheduled WorkflowValue PropositionValue Proposition
Preserve Order Continuity “Close the Loop” maintain accession number, avoid confusion with Filler
#, Placer #, etc.
Improve Demographic Integrity Data entry errors
• significant occurrence• significant consequences
Enter once, pass from system to system
6IHE Workshop – June 2006IHE Workshop – June 2006
Scheduled WorkflowScheduled WorkflowValue PropositionValue Proposition
Improve Workflow Efficiency Use of Worklists
• less time spent doing data entry/selection• enables semi-automation of setup
Reliable Storage Storage Commitment
• fewer lost studies• more confidence in results
7IHE Workshop – June 2006IHE Workshop – June 2006
Scheduled WorkflowScheduled WorkflowValue PropositionValue Proposition
Improve Order Tracking MPPS from Modality to RIS & PACS
• more timely feedback• more precise feedback
Reduce Integration Effort at Site Get Vendors on the Same Page Provide Implementation Guidance Pre-test at Connectathon
IHE Workshop – June 2006IHE Workshop – June 2006
IHE Workflow ConceptsIHE Workflow Concepts
PROCEDURE STEP : 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 has selected three UNAMBIGUOUS IHE has selected three UNAMBIGUOUS HL7/DICOM TERMS : TERMS :
ORDERORDER : : A request for radiologic serviceA request for radiologic service
REQUESTED PROCEDUREREQUESTED PROCEDURE : A Unit of work resulting in : A Unit of work resulting in one Reportone Report (with associated codified, billable acts) (with associated codified, billable acts)
IHE Workshop – June 2006IHE Workshop – June 2006
Workflow Concept MappingWorkflow Concept Mapping
This 3 level workflow structure is user oriented:
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.
IHE Workshop – June 2006IHE Workshop – June 2006
AcquisitionModality
Normal WorkflowNormal Workflow
ORDERA request for RadiologicService
Radiology Department
Set of Codifiable,
Billable, ActsOne or more series of images
PerformedProcedure
StepRequestedProcedure
ScheduledProcedure
Step
Report
DICOMModality Worklist
Typical workflow: One Order – One Procedure – One Report
IHE Workshop – June 2006IHE Workshop – June 2006
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 P2
DICOMModality Worklist
DICOMModality Worklist
12IHE Workshop – June 2006IHE Workshop – June 2006
Scheduled WorkflowScheduled Workflow“HL7 Actors & Transactions”“HL7 Actors & Transactions”
HL7 Actors:ADT/Patient Registration
Order Placer
DSS / Order Filler
Image Manager
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
13IHE Workshop – June 2006IHE Workshop – June 2006
Scheduled WorkflowScheduled WorkflowStandards UsedStandards Used
HL7 V2.3.1
Patient Registration• Admit: A01 (In Patient), A04 (Out Patient), A05 (Pre-Admission)• Cancel: A11 (Cancel Admit), A38 (Cancel Preadmit)
Patient Update• Transfer: A02 (Patient Transfer)• Update Patient Class: A03 (Discharge), A06(Outpatient becomes
Inpatient), A07 (Inpatient becomes Outpatient)• Update Patient Information: A08 (Update)• Merge Patients: A40 (Merge)• Cancel: A12 (Cancel Transfer), A13 (Cancel Discharge)
14IHE Workshop – June 2006IHE Workshop – June 2006
Scheduled WorkflowScheduled WorkflowStandards UsedStandards Used
HL7 V2.3.1
Order Management• New Order: ORM/NW & ORM/SN (New Order)• Order Status: ORM/SC (Status Change)• Cancel: ORM/CA, ORM/DC & ORM/OC (Cancel Order)
Procedure Details• Scheduled: ORM (Procedure Scheduled)• Updated: ORM (Procedure Updated)
15IHE Workshop – June 2006IHE Workshop – June 2006
Scheduled WorkflowScheduled Workflow“DICOM Actors & Transactions”“DICOM Actors & Transactions”
DICOM Actors:DSS / Order Filler
PPS Manager
Image Manager /Archive
Acquisition Modality
Evidence Creator
Image Display
Query Images [14] Retrieve Images [16]
Image Display
Storage Commitment [10]
Modality Image Stored [8] Storage Commitment [10]
Creator Images Stored [18]
Procedure Scheduled [4] Image Availability Query [11] Procedure Updated [13] Performed Work Status Update [42] Performed Work Status Update [42]
Modality Worklist Provided [5]
Evidence Creator
Performed Procedure
Step Manager
Modality PS in Progress [6] Modality PS Completed [7] Creator PS in Progress [20] Creator PS Completed [21]
Modality PS in Progress [6] Modality PS Completed [7] Creator PS in Progress [20] Creator PS Completed [21]
Modality PS in Progress [6] Modality PS Completed [7]
Creator PS in Progress [20] Creator PS Completed [21]
Acquisition Modality
Image Manager
Image Archive
DSS/ Order Filler
16IHE Workshop – June 2006IHE Workshop – June 2006
Acquisition Workflow ManagementAcquisition Workflow Management
DICOM:Modality Worklist Management (MWL)
Modality Performed Procedure Step (MPPS)
Query Images [14] Retrieve Images [16]
Image Display
Storage Commitment [10]
Modality Image Stored [8] Storage Commitment [10]
Creator Images Stored [18]
Procedure Scheduled [4] Image Availability Query [11] Procedure Updated [13] Performed Work Status Update [42] Performed Work Status Update [42]
Modality Worklist Provided [5]
Evidence Creator
Performed Procedure
Step Manager
Modality PS in Progress [6] Modality PS Completed [7] Creator PS in Progress [20] Creator PS Completed [21]
Modality PS in Progress [6] Modality PS Completed [7] Creator PS in Progress [20] Creator PS Completed [21]
Modality PS in Progress [6] Modality PS Completed [7]
Creator PS in Progress [20] Creator PS Completed [21]
Acquisition Modality
Image Manager
Image Archive
DSS/ Order Filler
17IHE Workshop – June 2006IHE Workshop – June 2006
Image ManagementImage Management
DICOM:Image Storage
Storage Commitment
Query/Retrieve
Query Images [14] Retrieve Images [16]
Image Display
Storage Commitment [10]
Modality Image Stored [8] Storage Commitment [10]
Creator Images Stored [18]
Procedure Scheduled [4] Image Availability Query [11] Procedure Updated [13] Performed Work Status Update [42] Performed Work Status Update [42]
Modality Worklist Provided [5]
Evidence Creator
Performed Procedure
Step Manager
Modality PS in Progress [6] Modality PS Completed [7] Creator PS in Progress [20] Creator PS Completed [21]
Modality PS in Progress [6] Modality PS Completed [7] Creator PS in Progress [20] Creator PS Completed [21]
Modality PS in Progress [6] Modality PS Completed [7]
Creator PS in Progress [20] Creator PS Completed [21]
Acquisition Modality
Image Manager
Image Archive
DSS/ Order Filler
19IHE Workshop – June 2006IHE Workshop – June 2006
Patient Information ReconciliationPatient Information ReconciliationExpect the Unexpected
20IHE Workshop – June 2006IHE Workshop – June 2006
Patient Information ReconciliationPatient Information ReconciliationAbstract / ScopeAbstract / Scope
Extension of Scheduled Workflow
Coordinated update of demographic information in workflow and content objects
21IHE Workshop – June 2006IHE Workshop – June 2006
Patient Information ReconciliationPatient Information ReconciliationValue PropositionValue Proposition
Handle “exception” cases Trauma/Emergent Cases
• Patient Unknown or no time for Registration Entry Errors by Operator Other Demographic Changes
• (e.g. married name)
Multiple sources/destinations for updates High risk of unsynchonized/inconsistent data
Workflow must continue
Need to pull together past & current patient records
22IHE Workshop – June 2006IHE Workshop – June 2006
Use CasesUse Cases
Local policy calls for ADT to pre-register ER patients (“John Doe”, “Jane Doe”): Case 1: Unidentified Patient registered at ADT
and order is placed at Order Placer. Case 2: Unidentified Patient registered at ADT
and order is placed at DSS/Order Filler. Case 3: Unidentified Patient registered at ADT but
acquisition completed at Modality prior to order.
23IHE Workshop – June 2006IHE Workshop – June 2006
Use CasesUse Cases
Local policy allows departments to register ER patients with Departmental IDs: Case 4: Unidentified Patient assigned temporary
Departmental ID and scheduled at DSS/Order Filler.
Case 5: Image Acquisition completed prior to assigning temporary Departmental ID or Order (Patient ID entered at the Modality).
24IHE Workshop – June 2006IHE Workshop – June 2006
Patient Information ReconciliationPatient Information ReconciliationTransaction DiagramTransaction Diagram
Patient Update [RAD-12]
Patient Update [RAD-12]
ADT
Images Availability Query [RAD-11] Patient Update [RAD-12] Procedure Update [RAD-13]
Query Modality Worklist [RAD-5]
Acquisition Modality
Image Manager
Image Archive
Modality PS in Progress [RAD-6] Modality PS Completed [RAD-7]
Order Placer
DSS/ Order Filler
Report Manager
Patient Update [RAD-12] Procedure Update [RAD-13]
Performed Procedure
Step Manager
Modality PS in Progress [RAD-6] Modality PS Completed [RAD-7]
Modality PS in Progress [RAD-6] Modality PS Completed [RAD-7]
Image Display
Query Images [RAD-14] Retrieve Images [RAD-16]
Report Creator/ Report Reader
Query Reporting Worklist [RAD-46] Query Reports [RAD-26] Retrieve Reports [RAD-27]
25IHE Workshop – June 2006IHE Workshop – June 2006
““Emergency” - Case 3Emergency” - Case 3
ADT OrderPlacer
ImageManager Modality
Department SystemDatabase/Scheduler/
Order Filler
Filler Order Mgmt
New Order [3]
ProcedureScheduled [4]
Patient Reconciliation
J.Doe -> J.Smith
PatientUpdate [12]
Schedule Procedure
ImagesAcquired
Modality ProcedureStep Completed [7]
Modality ProcedureStep Completed [7]
Register J.Doe
Patient
Update [12]
Patient
Registration [1]
26IHE Workshop – June 2006IHE Workshop – June 2006
More information….More information….
IHE Web site: www.ihe.net
Technical Frameworks & Supplements
Non-Technical Brochures :• Calls for Participation• IHE Fact Sheet and FAQ• IHE Integration Profiles: Guidelines for Buyers• IHE Connect-a-thon Results• Vendor Product Integration Statements
27IHE Workshop – June 2006IHE Workshop – June 2006
