HIMSS/RSNAVendor Workshop, Sep 2004 Notification Options for Scheduled Workflow Feedback Enhancements Andrei Leontiev L S Consulting

HIMSS/RSNAVendor Workshop, Sep 2004 IHE Radiology Integration Profiles Patient Info. Recon- ciliation Access to Radiology Information Consistent Present- ation of Images Basic Security - Evidence Docs Key Image Notes Simple Image & Numeric Reports Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting Scheduled Workflow Portable Data for Imaging NM Image

HIMSS/RSNAVendor Workshop, Sep 2004 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

HIMSS/RSNAVendor Workshop, Sep 2004 NEW SWF Options Departmental Appointment Notification –Gives the Department System Scheduler an option to notify Order Placer of date and time of scheduled examinations. Instance Availability Notification –Gives the Image Manager an option to notify Order Filler and other workflow management actors of availability status of evidence objects.

HIMSS/RSNAVendor Workshop, Sep 2004 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

HIMSS/RSNAVendor Workshop, Sep 2004 Departmental Appointment Notification Option

HIMSS/RSNAVendor Workshop, Sep 2004 Value Proposition Provides a mechanism for the Order Placer to keep track of appointments scheduled for a patient within Radiology Department Includes notifications of scheduling, re- scheduling and cancellation events Helps synchronization of scheduling processes between enterprise and radiology

HIMSS/RSNAVendor Workshop, Sep 2004 Background Existing Placer Order Management Transaction allows Order Placer specify preferred date and time of an order fulfillment (i.e., radiological examination) Order Filler is ultimately responsible for scheduling of examination as a succession of Procedure Steps that may require one or more appointments to be created Currently, Order Placer has no way to know when or where exactly the appointment will take place.

HIMSS/RSNAVendor Workshop, Sep 2004 Departmental Appointment Booking Use Case

HIMSS/RSNAVendor Workshop, Sep 2004 Appointment Notification Transaction Department System Scheduler/Order Filler generates Appointment Notification messages and sends them to the corresponding Order Placer actor. Order Placer receives Appointment Notification messages and internally processes them.

HIMSS/RSNAVendor Workshop, Sep 2004 Interaction Diagram

HIMSS/RSNAVendor Workshop, Sep 2004 Appointment Notification Transaction Three typical use cases –New booking: initial scheduling of an examination –Re-schedule: change in date/time of examination –Cancellation: examination cancellation Mechanism – HL7 SIU messages – One message may convey multiple appointments corresponding to a single order – One appointment corresponds to one or more Scheduled Procedure Steps

HIMSS/RSNAVendor Workshop, Sep 2004 SIU Message Structure SIU^S12, SIU^S13, SIU^S15 Schedule Information Unsolicited Chapter in HL7 V2.4/2.5 MSH SCH { RGS { AIS [ { NTE } ] } Message Header Schedule Activity Information Resource Group Segment Appt Information – Service Notes and Comments

HIMSS/RSNAVendor Workshop, Sep 2004 SCH Segment SEQLENDTOPTRP/#TBL#ITEM#ELEMENT NAME 175EIO00860Placer Appointment ID 275EIR00861Filler Appointment ID 422EIC00218Placer Group Number 6250CER00883Event Reason (^APT) 11200TQRY00884Appointment Timing Quantity (1) 16250XCNRY00885Filler Contact Person 20250XCNOY00878Entered by Person 2622EIRY00216Placer Order Number 2722EIRY00217Filler Order Number Specifies identification information of particular set of appointments for given Order

HIMSS/RSNAVendor Workshop, Sep 2004 SCH Segment Specifies common information for one or more appointments associated with single order – Placer Appointment ID is not used – Filler Appointment ID is required Appointment timing is defined on the Resource Group level, per Scheduled Procedure Step – SCH-6 has fixed value of 1 – One message can have multiple resource groups, thus multiple appointments (procedure steps) No patient identification information is required, thus Order Numbers are required

HIMSS/RSNAVendor Workshop, Sep 2004 RGS Segment Marks beginning of a resource group for a particular appointment. May contain only RGS-1. SEQLENDTOPTRP/#TBL#ITEM#ELEMENT NAME 14SIR01203Set ID – RGS 23IDC Segment Action Code 3250CEO01204Resource Group ID

HIMSS/RSNAVendor Workshop, Sep 2004 AIS Segment Specifies date/time and service type for an appointment (set of Scheduled Procedure Steps) SEQLENDTOPTRP/#TBL#ITEM#ELEMENT NAME 14SIR00890Set ID – AIS 23IDR Segment Action Code (A : Add/Insert) 3250CER00238Universal Service Identifier 426TSR01202Start Date/Time 520NMO00891Start Date/Time Offset 6250CEO00892Start Date/Time Offset Units 720NMO00893Duration 8250CEO00894Duration Units 910ISC Allow Substitution Code 10250CEC Filler Status Code 11250CEOY Placer Supplemental Service Information 12250CEOY Filler Supplemental Service Information

HIMSS/RSNAVendor Workshop, Sep 2004 AIS Segment Specifies Procedure Code and Description to for the Scheduled Procedure Step(s) included into this appointment – Procedure Code in components 1-3 – Not all steps of the procedure may be included – Those included are identified by a the text in component 5 Date/Time of an appointment is expected to be in UTC – If local, UTC offset is required No specification of location or resources (one should use AIG, AIL, AIP segments within the same group, as appropriate)

HIMSS/RSNAVendor Workshop, Sep 2004 NTE Segment Allows Order Filler to pass additional information, such as patient instructions, to Order Placer SEQLENDTOPTRP/#TBL#ITEM#ELEMENT NAME 14SIR00096Set ID – NTE 28IDR00097Source of Comment (L, O) FTR00098Comment 4250CER01318Comment Type (PI : Patient Instruction, RE: Remark)

HIMSS/RSNAVendor Workshop, Sep 2004 What is not in the option Departmental Appointment Notification Option does not allow Order Placer to request re-scheduling – it only can do it by cancel and re-order Transaction does not require AIL segment – thus notifications on re-scheduling of the service from one location to another may not be sent This option does not address needs of enterprise-wide scheduling

HIMSS/RSNAVendor Workshop, Sep 2004 References Profile Option - Volume 1, Section Transactions - Volume 3, Section 4.48

HIMSS/RSNAVendor Workshop, Sep 2004 Instance Availability Notification Option

HIMSS/RSNAVendor Workshop, Sep 2004 Value Proposition Enhances mechanism that allows to obtain information about availability of newly-acquired images and other evidence objects, for further use in workflow Provides this information to all workflow management actors

HIMSS/RSNAVendor Workshop, Sep 2004 Background DSS/Order Filler, Post-Processing Manager, Report Manager need to know when acquired evidence objects made it to the Archive –MPPS may be sent before objects are stored, and storage may fail –MPPS is not available to all managers –MPPS may fail or not be sent at all (media import) Existing query mechanism forces managers to poll Image Manager/Archive for availability of SOP Instances.

HIMSS/RSNAVendor Workshop, Sep 2004 Use Cases This option only addresses the use case when MPPS referencing evidence objects has been received by Image Manager. Image Manager generates Instance Availability Notification upon receiving of all objects referenced in particular MPPS. Cross-referencing of MPPS in IAN may compensate for MPPS missed by OF

HIMSS/RSNAVendor Workshop, Sep 2004 Instance Availability Notification Transaction

HIMSS/RSNAVendor Workshop, Sep 2004 Instance Availability Notification Transaction Image Manager/Image Archive generates an Instance Availability Notification message and send it to the DSS/Order Filler and optionally to other workflow managing actors (Post- Processing Manager, Report Manager). DSS/Order Filler, Post-Processing Manager, Report Manager receive an Instance Availability Notification message and internally process it.

HIMSS/RSNAVendor Workshop, Sep 2004 Interaction Diagram

HIMSS/RSNAVendor Workshop, Sep 2004 Instance Availability Notification SOP Class New SOP Class introduced in DICOM Supplement 93 –Normalized Service –N-CREATE Operation only –Can be used without association with MPPS – Does not convey and explicitly forbids adding of patient or procedure identifiers – Provides list of all object UIDs and their availability for retrieval, either over network or media (on per- image basis)

HIMSS/RSNAVendor Workshop, Sep 2004 Instance Availability Notification SOP Class New SOP Class introduced in DICOM Supplement 93 –No requirements when to generate notifications, for example: availability of the first instance of a Performed Procedure Step or Study upon its reception, availability of an entire set of instances comprising a completed Performed Procedure Step or Study Can be used without association with MPPS – Is not intended to satisfy scenarios or erroneous information reconciliation (see PIR profile)

HIMSS/RSNAVendor Workshop, Sep 2004 IAN N-CREATE Message Structure Attribute NameTagReq. Type N-CREATE (SCU/SCP) Specific Character Set(0008,0005)1C/1C (Required if an extended or replacement character set is used) All other Attributes of SOP Common Module3/3 Referenced Performed Procedure Step Sequence(0008,1111)2/2 >Referenced SOP Class UID(0008,1150)1/1 >Referenced SOP Instance UID(0008,1155)1/1 >Performed Workitem Code Sequence(0040,4019)2/2 >>Code Value(0008,0100)1/1 >>Coding Scheme Designator(0008,0102)1/1 >>Code Meaning(0008,0104)1/1 >>All other Attributes from Performed Workitem Code Sequence3/3 …

HIMSS/RSNAVendor Workshop, Sep 2004 IAN N-CREATE Message Structure (cont.) Attribute NameTagReq. Type N-CREATE (SCU/SCP) … Study Instance UID(0020,000D)1/1 Referenced Series Sequence(0008,1115)1/1 >Series Instance UID(0020,000E)1/1 >Referenced SOP Sequence(0008,1199)1/1 >>Referenced SOP Class UID(0008,1150)1/1 >>Reference SOP Instance UID(0008,1155)1/1 >>Instance Availability(0008,0056)1/1 >>Retrieve AE Title(0008,0054)1/1 >>Storage Media File-Set ID(0088,0130)3/3 >>Storage Media File-Set UID(0088,0140)3/3

HIMSS/RSNAVendor Workshop, Sep 2004 Instance Availability Values ONLINE means the instances are immediately available from the Retrieve AE Title, and if a C-MOVE were to be requested, it would succeed in a reasonably short time NEARLINE means the instances need to be retrieved from relatively slow media such as optical disk or tape, and if a C-MOVE were to be requested from the Retrieve AE Title, it would succeed, but may take a considerable time OFFLINE means that a manual intervention is needed before the instances may be retrieved, and if a C-MOVE were to be requested from the Retrieve AE Title, it would fail (e.g., by timeout) without such manual intervention. UNAVAILABLE means the instances cannot be retrieved from the Retrieve AE Title, and if a C-MOVE were to be requested, it would fail. Note that SOP Instances that are unavailable from this AE may be available from other AEs, or may have an alternate representation that is available from this AE.

HIMSS/RSNAVendor Workshop, Sep 2004 Trigger Events Image Manager shall send only one IAN message for each MPPS referencing at least one evidence object. Image Manager shall sent IAN when it received ALL instances referenced in MPPS Image Manager shall send IAN to DSS/OF, and optionally to other actors

HIMSS/RSNAVendor Workshop, Sep 2004 Message Semantics Timing of a message can vary significantly depending on timing of MPPS and object storage No message may be sent if complete object set never arrives No message may be sent if objects arrive without corresponding MPPS Even when objects are included in IAN, the retrieval request may fail due to errors

HIMSS/RSNAVendor Workshop, Sep 2004 Expected Actions Actors receiving IAN message are expected to use its content for workflow management. Examples of internal actions: – The Department System Scheduler/Order Filler may update the procedure status internally, indicating that images for the procedure have been stored. – The Post-Processing Manager may add or re- arrange items to a corresponding worklist. – The Report Manager add items to a corresponding worklist.

HIMSS/RSNAVendor Workshop, Sep 2004 References Profile Option - Volume 1, Chapter 3 Transactions - Volume 3, Section 4.49

HIMSS/RSNAVendor Workshop, Sep 2004 More information…. IHE Web sites: Technical Frameworks: ITI V1.0, RAD V5.5, LAB V1.0 Technical Framework Supplements - Trial Implementation May 2004: Radiology August 2004: Cardiology, IT Infrastructure Non-Technical Brochures : Calls for Participation IHE Fact Sheet and FAQ IHE Integration Profiles: Guidelines for Buyers IHE Connect-a-thon Results Vendor Products Integration Statements

HIMSS/RSNAVendor Workshop, Sep 2004 Questions, Comments, and/or Suggestions?