Sept 13-15, 2004IHE Interoperability Workshop 1 Integrating the Healthcare Enterprise Scheduled Workflow: The First Profile Don Van Syckle, DVS Consulting, Inc. Modified version of profiles delivered in workshop identified below – delivered by Kevin ODonnell

Sept 13-15, 2004IHE Interoperability Workshop 2 Profile Summary Fundamental Starting Point of IHE Addresses Registration, Scheduling, Acquisition Workflow and Image Content Bridges HL7 and DICOM Spaces

Sept 13-15, 2004IHE Interoperability Workshop 3 Motivation 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

Sept 13-15, 2004IHE Interoperability Workshop 4 Motivation 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

Sept 13-15, 2004IHE Interoperability Workshop 5 Motivation 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

Sept 13-15, 2004IHE Interoperability Workshop 6 Scheduled Workflow Profile Registration Orders Placed Orders Filled Film Folder Image Manager & Archive Film Lightbox report Report Repository Diagnostic Workstation Modality acquisition in-progress acquisition completed images printed Acquisition Modality

IHE 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 TERMS : IHE has selected three UNAMBIGUOUS HL7/DICOM TERMS : ORDER : A request for radiologic service ORDER : A request for radiologic service REQUESTED PROCEDURE : A Unit of work resulting in one Report (with associated codified, billable acts) REQUESTED PROCEDURE : A Unit of work resulting in one Report (with associated codified, billable acts)

Workflow Concept Mapping This 3 level workflow structure is user oriented: ORDER: A request for imaging service (Accession Number) REQUESTED PROCEDURE : Units of work resulting in one Report with associated codified, billable acts (Requested Procedure ID) PROCEDURE STEP : The smallest unit of work in the workflow (modality worklist entry) CLINICIAN OR REFERING DOC: The Imaging Dept Customer RADIOLOGIST : In Charge of producing the Report the Report TECHNOLOGIST (and RADIOLOGIST) In charge of acquiring images, etc.

Acquisition Modality Normal Workflow ORDER A request for Radiologic Service Radiology Department Set of Codifiable, Billable, Acts One or more series of images Performed Procedure Step Requested Procedure Scheduled Procedure Step Report DICOM Modality Worklist Typical workflow: One Order – One Procedure – One Report

Acquisition Modality Multiple Modality Steps ORDER A request for Radiologic Service Radiology Department Set of Codifiable, Billable, Acts One or more series of images Performed Procedure Step P1 Scheduled Procedure Step B Requested Procedure 1 Scheduled Procedure Step A Report One or more series of images Performed Procedure Step P2 DICOM Modality Worklist

Sept 13-15, 2004IHE Interoperability Workshop 11 Administrative Normal Process Flow

Sept 13-15, 2004IHE Interoperability Workshop 12 Procedure Performance Normal Process Flow

Sept 13-15, 2004IHE Interoperability Workshop 13 HL7 Actors in SWF HL7 Actors: ADT/Patient Registration Order Placer DSS / Order Filler Image Manager

Sept 13-15, 2004IHE Interoperability Workshop 14 ADT Actor Primary Patient Info Entry

Sept 13-15, 2004IHE Interoperability Workshop 15 ADT Transactions Patient Registration Send Admit: A01 (In Patient), A04 (Out Patient), A05 (Pre-Admission) Cancel: A11 (Cancel Admit), A38 (Cancel Preadmit) Patient Update Send 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)

Sept 13-15, 2004IHE Interoperability Workshop 16 Order Placer Actor Primary Order Entry

Sept 13-15, 2004IHE Interoperability Workshop 17 Order Placer Transactions Placer Order Management Send New Order: ORM/NW (New Order) Cancel: ORM/CA (Cancel Order), ORM/DC (Discontinue) Patient Registration Receive Patient Update Receive Filler Order Management Receive

Sept 13-15, 2004IHE Interoperability Workshop 18 Department System Scheduler / Order Filler Actor Primary Scheduling & Order Management

Sept 13-15, 2004IHE Interoperability Workshop 19 DSS/Order Filler Transactions Order Filler Management Send New Order: ORM/SN (New Order) Order Status: ORM/SC (Status Change) Cancel: ORM/OC (Cancel Order) Procedure Scheduled Send ORM (procedure scheduled) Procedure Updated Send ORM (procedure updated)

Sept 13-15, 2004IHE Interoperability Workshop 20 DSS/Order Filler (Cont.) Patient Registration Receive Patient Update Receive Placer Order Management Receive

Sept 13-15, 2004IHE Interoperability Workshop 21 DICOM Actors in SWF DICOM Actors: DSS / Order Filler PPS Manager Image Manager / Archive Acquisition Modality Evidence Creator Image Display

Sept 13-15, 2004IHE Interoperability Workshop 22 Acquisition Workflow Management DICOM: Modality Worklist Management (MWL) Modality Performed Procedure Step (MPPS)

Sept 13-15, 2004IHE Interoperability Workshop 23 Image Management DICOM: Image Storage Storage Commitment Query/Retrieve

Sept 13-15, 2004IHE Interoperability Workshop 24 Additional Workflow Management HL7: ORM Message DICOM: Query (C-FIND) Modality Performed Procedure Step (MPPS)

Sept 13-15, 2004IHE Interoperability Workshop 25 Some Transaction Details Modality Worklist Provided DSS/Order Filler is Responsible for translating HL7 orders into DICOM Worklist Modality PPS In-Progress 4.20 – Creator PPS In-Progress MPPS N-Create (Start), N-Set (Updates) Modality PPS Completed 4.21 – Creator PPS Completed MPPS N-Set (Complete) Image Availability Query C-FIND (Study Root Query, Hierarchical) Performed Work Status Update N-SET (Complete)