Sept 13-15, 2004IHE Interoperability Workshop 1 Integrating the Healthcare Enterprise Post-Processing Workflow Sanjay Jain Co-Chair, Radiology Planning Committee

Sept 13-15, 2004IHE Interoperability Workshop 2 IHE Radiology Integration profiles Patient Informa- tion Reconci- liation Consistent Presentation of Images Scheduled Workflow Evidence Documents Key Image Notes Simple Image and Numeric Reports Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting triggers required for workflow management required for content Access to Radiology Information Basic Security Portable Data for Imaging

Sept 13-15, 2004IHE Interoperability Workshop 3 Post-processing Workflow Objectives Schedule, distribute and track post- processing workflow steps using standardized mechanisms Worklists for each task are generated and can be queried Workitems can be performed and the resulting status known and shared

Sept 13-15, 2004IHE Interoperability Workshop 4 Measurements CAD report……………… Store Images Store SR Storage Commitment List of Images/SR Post-Processing Workflow with Post-Processing Manager grouped with Image Manager Post-Processing Worklist Worklist Workitem Claimed PP-Performed Step Started Workitem Completed PP-Performed Step Completed PP-Performed Step: Pat Name/ID Accession #, Study UID Performed Status = Started Post- Processing Performed Procedure Step PP-Performed Step: Complete List of Images/SR Performed Status = Completed Image Manager/Archive & Post Processing Manager OF/DSS 3-D Workstation

Sept 13-15, 2004IHE Interoperability Workshop 5 Acquisition Modality Post- Processing Modality and Post-Processing Steps ORDER A request for Radiological Service Radiology Department Set of Codifiable, Billable Acts One or more series of images M-Perf. Procedure Step P1 Requested Procedure 1 Scheduled Procedure Step B Scheduled Procedure Step A Report One or more series of images PP-Perf. Procedure Step P2 DICOM Modality Worklist DICOM Post-Processing Worklist

Sept 13-15, 2004IHE Interoperability Workshop 6 Actors & Transactions additional actor: Post-Processing Manager transactions: Worklist Provided Workitem Claimed Workitem PPS In Progress Workitem PPS Completed Workitem Completed Performed Work Status Update Evidence Documents Stored Query Evidence Documents Retrieve Evidence Documents

Sept 13-15, 2004IHE Interoperability Workshop 7 Post-Processing Manager Grouping Post-Processing Manager is grouped either with Image Manager Post-Processing Manager IM/IA DSS/OF Performed Work Status Update (optional) PWF Profile SWF Profile

Sept 13-15, 2004IHE Interoperability Workshop 8 or with DSS/OF Post Processing Manager IM/IA DSS/OF PWF Profile SWF Profile Performed Work Status Update Post-Processing Manager Grouping

Sept 13-15, 2004IHE Interoperability Workshop 9 Post- Processing Manager DSS/Order Filler Image Display Evidence Creator Performed Work Status Update Worklist Provided Workitem Claimed Workitem PPS In Progress Workitem PPS Completed Workitem Completed Query Images Retrieve Images Query Evidence Documents Retrieve Evidence Documents Images Stored Storage Commitment Evidence Documents Stored Actors & Transactions DSS/OF Post- Processing Manager Image Availability Query IM/IA

Sept 13-15, 2004IHE Interoperability Workshop 10 Worklist Provided Evidence Creator finds out what post-processing tasks have been scheduled or assigned to it by the Post-Processing Manager Worklist provided for workitem codes e.g. Image Processing or Computer Aided Detection. Evidence Creator includes received information in the resulting instances

Sept 13-15, 2004IHE Interoperability Workshop 11 Worklist Provided General Purpose Worklist SOP Class Explicit definition of required matching and return keys for both Post-Processing Manager and Evidence Creator Evidence Creator shall implements at least one of three query cases: Patient Oriented Station Oriented Class Oriented Post-Processing Manager Evidence Creator C-Find-RQ C-Find-RSP

Sept 13-15, 2004IHE Interoperability Workshop 12 Patient Oriented Query Worklist for a specific patient/procedure SCU shall support all combinations of the matching keys Patient's Name Patient ID Referenced Request Sequence >Accession Number >Requested Procedure ID Scheduled Workitem Code Sequence >Code Value >Coding Scheme Designator

Sept 13-15, 2004IHE Interoperability Workshop 13 Station Oriented Query Broad worklist for a particular workstation SCU must support all combinations of the matching keys General Purpose Scheduled Procedure Step Status Scheduled Station Name Code Sequence >Code Value >Coding Scheme Designator Scheduled Procedure Step Start Date and Time Scheduled Workitem Code Sequence >Code Value >Coding Scheme Designator

Sept 13-15, 2004IHE Interoperability Workshop 14 Class Oriented Query Broad worklist for a particular class of workstations SCU must support all combinations of the matching keys General Purpose Scheduled Procedure Step Status Scheduled Station Name Code Sequence >Code Value >Coding Scheme Designator Scheduled Procedure Step Start Date and Time Scheduled Workitem Code Sequence >Code Value >Coding Scheme Designator

Sept 13-15, 2004IHE Interoperability Workshop 15 Input Availability Needed in case the Post-Processing Manager is not being grouped with the Image Manger The Post-Processing Manager uses Image Availability Query to know when images are available. Post-Processing Manager and Evidence Creator must be able to handle workitems with PARTIAL Image Availability in a stable way.

Sept 13-15, 2004IHE Interoperability Workshop 16 Input Information Evidence Creator may retrieve Input Objects using Input Information Sequence provided in the worklist response. Input Objects may be made available at the Evidence Creator by means of workflow rules such as auto-routing. Post-Processing Manager Evidence Creator C-Find-RQ C-Find-RSP IM/IA Retrieve / Send Images, Evidence Documents

Sept 13-15, 2004IHE Interoperability Workshop 17 Workitem Claimed Evidence Creator takes ownership of the workitem Post-Processing Manager updates its worklist and permits other worklist users to detect that this SPS has been claimed

Sept 13-15, 2004IHE Interoperability Workshop 18 Workitem Claimed General Purpose Scheduled Procedure Step SOP Class N-ACTION (SPS in Progress) Post-Processing Manager Evidence Creator

Sept 13-15, 2004IHE Interoperability Workshop 19 Workitem Performed Procedure Step In Progress Evidence Creator starts work on claimed SPS Notifies Post-Processing Manager to create a Performed Procedure Step

Sept 13-15, 2004IHE Interoperability Workshop 20 Workitem Performed Procedure Step In Progress General Purpose Performed Procedure Step SOP Class SPS and PPS relationships (Appendix III-D): Simple Case Unscheduled Case Append Case Abandoned Case N-CREATE (PPS in Progress) Post-Processing Manager Evidence Creator

Sept 13-15, 2004IHE Interoperability Workshop 21 Workitem Performed Procedure Step Completed Evidence Creator notifies Post-Processing Manager of the PPS completion Evidence Creator references any results created e.g. images, evidence documents

Sept 13-15, 2004IHE Interoperability Workshop 22 Workitem Performed Procedure Step Completed General Purpose Performed Procedure Step SOP Class Evidence Creator shall send to the Post-Processing Manager a list of all Composite SOP Instances in the Output Information Sequence (0040,4033) N-Set (PPS Completed) Post-Processing Manager Evidence Creator

Sept 13-15, 2004IHE Interoperability Workshop 23 Workitem Completed Evidence Creator notifies the Post-Processing Manager when it completes the scheduled workitem Post-Processing Manager updates its worklist

Sept 13-15, 2004IHE Interoperability Workshop 24 Workitem Completed General Purpose Scheduled Procedure Step SOP Class No further PPS will be created for this SPS N-ACTION (SPS Completed) Post-Processing Manager Evidence Creator

Sept 13-15, 2004IHE Interoperability Workshop 25 Performed Work Status Update Department System Scheduler and Image Manager inform each other of the status of performed post-processing work Allows the system not managing the performed work to stay in sync

Sept 13-15, 2004IHE Interoperability Workshop 26 Performed Work Status Update General Purpose Performed Procedure Step SOP Class Performed Workitem Code Sequence (one workitem) Requested Subsequent Workitem Code Sequence (next workitem) Image Manager DSS/OF N-CREATE (PPS in Progress) N-SET (PPS Completed)

Sept 13-15, 2004IHE Interoperability Workshop 27 Wrap Up Post-Processing Workflow (Multiple Steps) with Post-Processing Manager grouped with Image Manager RIS PACS Modality DICOM MWL DICOM Image Storage DICOM Storage Commitment DICOM MPPS DICOM MPPS CAD Station Post-Processing Station DICOM PP-WL DICOM PP-SPS DICOM PP-WL DICOM PP-SPS DICOM PP-PPS DICOM PP-PPS DICOM PP-PPS DICOM Storage & Commitment DICOM Q/R DICOM Storage & Commitment

Sept 13-15, 2004IHE Interoperability Workshop 28 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 Questions?