Integrating the Healthcare Enterprise Improving Clinical Care: IHE Integration Profiles in Detail

Charles Parisot –Member IHE Technical and Planning Committees –GE Medical Systems – Information Technologies Sanjay Jain –Co-Chair IHE Planning Committee –Cerner Corporation, Radiology and Clinical Imaging Andrei Leontiev –Co-Chair IHE Technical Committee –IDX Systems Co-authors and Presenters

RSNA An RSNA & HIMSS Initiative promoting and supporting the integration of systems in a healthcare enterpriseAn RSNA & HIMSS Initiative promoting and supporting the integration of systems in a healthcare enterprise To improve efficiency and quality of clinical practiceTo improve efficiency and quality of clinical practice Serious Integration Challenges:Serious Integration Challenges: Systems need info that other systems haveSystems need info that other systems have Systems communicate poorly or not at allSystems communicate poorly or not at all Result in tedious inefficient workflows and data inconsistentResult in tedious inefficient workflows and data inconsistent Understanding the Clinical Benefits.. ……the IHE Integration Profiles IT/Imaging Integration Challenge IHE, A Novel Approach

RSNA Access to Radiology Information Consistent access to images and reports Consistent Presentation of Images Hardcopy and softcopy grayscale presentation state Key Image Notes Flag significant images Simple Image and Numeric Reports Simple reports with image links and, optionally, measurements Basic Security Audit Trail Consolidation & Node Authentication Presentation of Grouped Procedures Subset a single acquisition Post- Processing Workflow Schedule, perform, & notify image processing & CAD steps Charge Posting Collection of billable procedure details Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Patient Information Reconciliation Unknown patients and unscheduled orders Integration Profiles

RSNA Problems Before the Technologist performs the acquisition, how do I make sure the correct info is used ?Before the Technologist performs the acquisition, how do I make sure the correct info is used ? Paper based workflow with data re-entryPaper based workflow with data re-entry Risk of error AND InefficientRisk of error AND Inefficient Stale informationStale information Changes between time of print and time of data entryChanges between time of print and time of data entry Cancel orders, Generic Order / Order ChangesCancel orders, Generic Order / Order Changes After the Technologist completes acquisition, how do I let all systems know ?After the Technologist completes acquisition, how do I let all systems know ? When are things ready to be read (PACS)When are things ready to be read (PACS) When can things be deleted (Modality)When can things be deleted (Modality) How do I know what to bill (RIS)How do I know what to bill (RIS) When do I wake up the referring physicianWhen do I wake up the referring physician The solution is……

RSNA Store Images Storage Commitment List of Images PACS & Archive RIS ModalityPerformed Procedure Step A Closed Loop Update IS SchedulingUpdate IS Scheduling Match Procedure with OrderMatch Procedure with Order Support Billing Based on MPPSSupport Billing Based on MPPS Avoid Reading incomplete ProceduresAvoid Reading incomplete Procedures IHE Scheduled Workflow Modality Worklist Procedure Scheduled Patient Registration/Update Order Management With Performed Acquisition Protocols Proposed Protocols Loaded and Reviewed Order Protocolized Worklist Pt A, …, SPS=P1, P4 Pt C, …, SPS=P1, P5 Pt B, …, SPS=P2 Pt E, …, SPS=P4 Performed Step: Status = Completed Performed Procedure: CT Head Performed Protocol Code=P1 Performed Protocol Code=P1 Pat Name/ID, Dose, Accession #, Study UID Complete List of Images Scheduled Protocol Code=P1, P5

RSNA 2002 IHE Workflow Concepts Procedure Steps : The smallest unit of work in the workflow: : ‘A unit of work to do’ : ‘A unit of work done’ Procedure Steps : 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 identifies four fundemental workflow information units. : A Unit of Reporting Work with associated codified, billable acts REQUESTED PROCEDURE : A Unit of Reporting Work with associated codified, billable acts A request for radiologic service ORDER : A request for radiologic service "Assisted Acquisition Protocol Setting" option operates at the Scheduled and Performed Procedure Step Level

RSNA 2002 IHE Workflow is User Driven Information Unit has its Prime User Information Unit has its Prime User 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.  Assisted Protocols provide a New Level of efficiency

RSNA Examples of Protocol Codes A Scheduled Procedure Step may contain a single Protocol Code: “Standard Chest X-ray” Protocol Code. This implies PA and Lateral views.“Standard Chest X-ray” Protocol Code. This implies PA and Lateral views. “Screening Mammography” Protocol Code. This implies RMLO and LMLO, RCC and LCC views.“Screening Mammography” Protocol Code. This implies RMLO and LMLO, RCC and LCC views.

RSNA Examples of Protocol Codes “MRI Acquisition” Prot. Code followed by an “MRA Acquisition” Prot. Code.“MRI Acquisition” Prot. Code followed by an “MRA Acquisition” Prot. Code. “CT Head without contrast” Prot. Code followed by a “CT with contrast” Prot. Code.“CT Head without contrast” Prot. Code followed by a “CT with contrast” Prot. Code. “CT Lumbar Spine” Prot. Code followed by a “Reformation of the discs” Prot. Code.“CT Lumbar Spine” Prot. Code followed by a “Reformation of the discs” Prot. Code. “CT Thorax” prot. Code followed by a “Recon with lung kernel” Prot. Code.“CT Thorax” prot. Code followed by a “Recon with lung kernel” Prot. Code. A Scheduled Procedure Step may also contain multiple Protocol Codes for more complex SPS with several acquisition or image processing tasks be performed in a sequential manner, for example:

RSNA 2002 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

RSNA 2002 Acquisition Modality Discontinued Procedure Step ORDER A request for Radiologic Service Radiology Department One or more series of images Performed Procedure Step P1 Report Set of Codifiable, Billable, Acts Requested Procedure 2 Scheduled Procedure Step C Requested Procedure 1 Scheduled Procedure Step A DICOM Modality Worklist No Performed Procedure Step Discontinue

RSNA Store Images Storage Commitment List of Images PACS & Archive RIS ModalityPerformed Procedure Step Performed Step: Status = Completed Performed CT Head Pat Name/ID, Dose, Accession #, Study UID Complete List of Images A Closed Loop Update IS SchedulingUpdate IS Scheduling Match Procedure with OrderMatch Procedure with Order Support Billing Based on MPPSSupport Billing Based on MPPS Avoid Reading incomplete ProceduresAvoid Reading incomplete Procedures IHE Scheduled Workflow with Exception Management Modality Worklist Worklist Procedure Scheduled Step Discontinued With Reason If Wrong Worklist Images "removed“ and Step "undone"

RSNA Problems John Doe Trauma Clean-UpJohn Doe Trauma Clean-Up Recovering After Systems Are DownRecovering After Systems Are Down Error in manual entry at modalityError in manual entry at modality VIP PrivacyVIP Privacy The solution is……

RSNA Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Patient Information Reconciliation Unknown patients and unscheduled orders Integration Profiles

RSNA IHE Scheduled Workflow + IHE Patient Information Reconciliation ADT Patient Registration Order Placer Dept Scheduler Image Manager/Archive Modality When Institution Policy assumes pre- registration of ER patients (John/Jane Doe), IHE supports 3 possible cases:When Institution Policy assumes pre- registration of ER patients (John/Jane Doe), IHE supports 3 possible cases: 1.Unidentified Patient registered at ADT and order placed at Order Placer 2.Unidentified Patient registered at ADT and order placed at Department Scheduler/Order Filler 3.Unidentified Patient registered at ADT but acquisition completed at Modality prior to Order PACS is synchronized with all patient registration and order information updates through Dept Scheduler.PACS is synchronized with all patient registration and order information updates through Dept Scheduler.

RSNA IHE Scheduled Workflow + IHE Patient Information Reconciliation ADT Patient Registration Order Placer Dept Scheduler Image Manager/Archive Modality When Institution Policy allows departments to register ER patients, IHE supports 2 possible cases:When Institution Policy allows departments to register ER patients, IHE supports 2 possible cases: 1.Unidentified Patient assigned Temporary Departmental ID and Scheduled at Dept Scheduler/Order Filler 2.Image Acquisition Completed Without Scheduling at Dept Scheduler/Order Filler (Patient ID entered at Modality) Supports cases when ADT or Dept Scheduler is downSupports cases when ADT or Dept Scheduler is down

RSNA Problems Schedule and track post-processing workflow steps for accuracy of workSchedule and track post-processing workflow steps for accuracy of work Share workload among workstations, chain workflow steps to avoid redundancyShare workload among workstations, chain workflow steps to avoid redundancy Store and Query/Retrieve of Evidence Documents for CAD, Image Processing etc.Store and Query/Retrieve of Evidence Documents for CAD, Image Processing etc. The solution is……

RSNA Post- Processing Workflow Schedule, perform, & notify image processing & CAD steps Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Patient Information Reconciliation Unknown patients and unscheduled orders Integration Profiles

RSNA Post-Processing Workflow Profile Post-Proc.WorkflowManager PACS System CAD *Workstation Report Repository Acquisition Modality 3-D *Workstation Work Status Worklist … Source Data Results Workstation Results Work Status

RSNA 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

RSNA Worklist Provided Modality finds out what post-processing tasks have been scheduled by the Post-Processing Manager (RIS or PACS)Modality finds out what post-processing tasks have been scheduled by the Post-Processing Manager (RIS or PACS) Worklist is provided for workitem codes: Image Processing, Computer Aided Diagnosis, and Computer Aided Detection.Worklist is provided for workitem codes: Image Processing, Computer Aided Diagnosis, and Computer Aided Detection. Modality includes received information in the resulting instancesModality includes received information in the resulting instances

RSNA Evidence Document Stored Acquisition Modality stores an Evidence Document to PACSAcquisition Modality stores an Evidence Document to PACS –Non-image evidence for diagnostic interpretation –DICOM Structured Reporting documents or Waveforms, e.g. Mammography CAD SR, Basic Text SR, Enhanced SR, Comprehensive SR

RSNA Problems The solution is…… How to standardize the Charge Posting and billing for work performedHow to standardize the Charge Posting and billing for work performed How to Reduce System Interface Installation Time between Clinical Systems and the Charge ProcessorsHow to Reduce System Interface Installation Time between Clinical Systems and the Charge Processors How to avoid Billing System needing to know the Radiology InternalsHow to avoid Billing System needing to know the Radiology Internals

RSNA Post- Processing Workflow Schedule, perform, & notify image processing & CAD steps Charge Posting Collection of billable procedure details Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Patient Information Reconciliation Unknown patients and unscheduled orders Integration Profiles

RSNA Charge Posting Profile ChargePoster *Billing System CAD *Workstation Report Repository … Report Generated / Signed CAD Performed Post Charges Acquisition Modality ADT Terminal 3-D *Workstation Account Management 3-D Performed Study Performed / Materials Used

RSNA Workflow RIS indicates to the Billing System that procedures are available for Technical and/or Professional billing – maintain accuracyRIS indicates to the Billing System that procedures are available for Technical and/or Professional billing – maintain accuracy Charge Posted Transaction may be sent at various times in the workflow - flexibilityCharge Posted Transaction may be sent at various times in the workflow - flexibility –Regulations and site policies determine when a procedure is eligible for Charge Posting

RSNA Problems Ensuring print quality outside of the departmentEnsuring print quality outside of the department Radiologist discussing images with remote physiciansRadiologist discussing images with remote physicians Capture image manipulation to avoid redundant work (coronal CT, MR reading, etc.)Capture image manipulation to avoid redundant work (coronal CT, MR reading, etc.) The solution is……

RSNA Consistent Presentation of Images Hardcopy and softcopy grayscale presentation state Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Patient Information Reconciliation Unknown patients and unscheduled orders Integration Profiles Post- Processing Workflow Schedule, perform, & notify image processing & CAD steps Charge Posting Collection of billable procedure details

Original Image The Radiologist Saves a New Presentation State: What the Reviewing Physician Sees: The Radiologist’s Transformations Are Saved With Presentation State Original Image+Windowing +Zoom Area Of Interest +Annotation Inconsistent Presentation On an Uncalibrated Display Consistent Presentation of Images On a Calibrated Display Area Of Interest All the Transformations Are Completely Lost No Presentation State Image Original Image Radiologist Views Images

RSNA 2002 Grayscale Standard Display Function (GSDF) Acquisition Soft Copy Review Film Review 6 modalities  4 cameras, 26 workstations The current way = 180 calibrations Independent device calibration delivers consistency with simplicity Barten Curve Just Noticeable Differences LuminanceLuminanceLuminanceLuminance DICOM Standard Display Function The IHE way = only 36 calibrations

RSNA Consistent Presentation of Images With films, image quality was the imaging department problem….With films, image quality was the imaging department problem…. Softcopy image distribution across the healthcare enterpriseSoftcopy image distribution across the healthcare enterprise –Enabled by digital radiology –Avoids lost films, reduce delays –Decreases utilization of staff and equipment –But …need to ensure quality and consistency ! This IHE Integration Profile is the cost effective and technically correct solution.This IHE Integration Profile is the cost effective and technically correct solution.

RSNA Problems An hematologist/oncologist orders:An hematologist/oncologist orders: –“CT CAP, Lymphoma, R/O disease” –We do “CT CHEST, ABDOMEN, PELVIS w/CON” –3 orders in RIS, 3 accession numbers, 3 CPTs, 3 reports –Chest radiologist will read chest –Body Imager will read abdomen and pelvis With One Spiral CT Exam what do we do ?With One Spiral CT Exam what do we do ? The solution is……

RSNA Consistent Presentation of Images Hardcopy and softcopy grayscale presentation state Presentation of Grouped Procedures Subset a single acquisition Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Patient Information Reconciliation Unknown patients and unscheduled orders Integration Profiles Post- Processing Workflow Schedule, perform, & notify image processing & CAD steps Charge Posting Collection of billable procedure details

RSNA MODALITY IHE – Presentation of Grouped Procedures Requested Procedure: CHEST Report: CHEST Requested Procedure: ABDOMEN Report: ABDOMEN Performs a single exam Operator groups 2 procedures Chest View Abdomen View RIS / PACS Chest View Abdomen View

RSNA Presentation of Grouped Procedures PGP maintains the link back to each one of the grouped procedures: PGP maintains the link back to each one of the grouped procedures: –without breaking the acquisition apart –Without duplicating images PGP ensures that each image subset related to a requested procedure is identified and ready to be presented. PGP ensures that each image subset related to a requested procedure is identified and ready to be presented.  This is key for quick display of new and prior studies.

RSNA Other Group/Split cases… CT:Head bone / brain separationCT:Head bone / brain separation CR:Foot/ankle - hand/wristCR:Foot/ankle - hand/wrist –E.g., lateral image of foot shared between AP of ankle and AP of foot DR:Trauma patient AP / Lat re-groupingDR:Trauma patient AP / Lat re-grouping –I.e., do all the Aps then rotate the patient once then do Lats MR:MRI/MRAMR:MRI/MRA –To be viewed and billed separately IR:Diagnostic run and therapeutic runIR:Diagnostic run and therapeutic run –Performed contemporaneously, viewed/billed separately US:Abdomen and kidneys/ retroperitoneumUS:Abdomen and kidneys/ retroperitoneum The solution is……

RSNA Problems Will you ask your technologist to push Mr. Smith’s study and report to our Radiation Therapy planning system?”Will you ask your technologist to push Mr. Smith’s study and report to our Radiation Therapy planning system?” “No.”“No.” The solution is……

RSNA Access to Radiology Information Consistent access to images and reports Consistent Presentation of Images Hardcopy and softcopy grayscale presentation state Presentation of Grouped Procedures Subset a single acquisition Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Patient Information Reconciliation Unknown patients and unscheduled orders Integration Profiles Post- Processing Workflow Schedule, perform, & notify image processing & CAD steps Charge Posting Collection of billable procedure details

RSNA Radiology Department Images and Reports Emergency Department Referring Physician Other Departments: - Oncology - Surgery - Neurology - Pediatrics - etc. Remote Clinics Electronic Medical Record Access to Radiology Information

RSNA Problems “Dave, you read that 3000 slice MR study last night. Can you highlight the 5 most important images for me”“Dave, you read that 3000 slice MR study last night. Can you highlight the 5 most important images for me” –Thinking… You”, says “Sure” You “Dr., I just reviewed 40 cases and marked my questions on yellow stickies. Can you review those”“Dr., I just reviewed 40 cases and marked my questions on yellow stickies. Can you review those” Tech to radiologist: “The patient wouldn’t hold still”Tech to radiologist: “The patient wouldn’t hold still” The solution is……

RSNA Access to Radiology Information Consistent access to images and reports Consistent Presentation of Images Hardcopy and softcopy grayscale presentation state Key Image Notes Flag significant images Presentation of Grouped Procedures Subset a single acquisition Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Patient Information Reconciliation Unknown patients and unscheduled orders Integration Profiles Post- Processing Workflow Schedule, perform, & notify image processing & CAD steps Charge Posting Collection of billable procedure details

RSNA The radiologist selects Key Images, and creates appropriate Notes. for refering physician In this image you can see the hematoma. Note 2: for refering physician In this image you can see the renal rupture. Note 1: The referring physician views the Key Image Note prepared by radiologist. for refering physician In this image you can see the renal rupture. Note 1: for refering physician In this image you can see the hematoma. Note 2: Results in improved communication between the radiologist and the referring physician

RSNA The radiologist selects Key Images, and creates appropriate Notes. The referring physician views the Key Image Note prepared by radiologist. Results in improved communication between the radiologist and the referring physician for refering physician Hematoma everywhere Note 3: for refering physician In this image you can see the hematoma. Note 3:

RSNA Key Image Notes There is more to teamwork than images and reportsThere is more to teamwork than images and reports With IHE, it is possible to attach « electronic post-it™ » to images to increase informal but critical communication between:With IHE, it is possible to attach « electronic post-it™ » to images to increase informal but critical communication between: –The Technologist and the Radiologist about specific examination events –The Radiologist and the Technologist about image quality issues –The Radiologist and other department clinicians (surgeon, orthopedist,..) –The Radiologist and collegues about selecting images for conferences –The Radiologist to the Referring Provider, …..etc. This IHE Integration Profile is the cost effective solution (increases radiology and overall efficiency).This IHE Integration Profile is the cost effective solution (increases radiology and overall efficiency).

RSNA Can You Make A Report Like This? Institution Identification Patient Identification Study Identification Technique Identification Discussion The liver is normal. There is a focal area of decreased attenuation adjacent to the falciform ligt., likely representing focal fat (image 22). The spleen, both kidneys, the … are normal. Impression CT of the abdomen within normal limits Signature The solution is……

RSNA Or Like That ? Discussion Comparison is made to the prior study of 4/11/99. The left paratracheal lymph node (image 8, image 11) now measures 2.5x2.7x3.1 cm increasing from 2.0x2.1x2.6 previously. No other mediastinal, upper abdominal or axillary adenopathy is identified. No focal pulmonary lesions are seen. The…………… are normal. Impression Worsening L Paratracheal adenopathy. Signature

RSNA Access to Radiology Information Consistent access to images and reports Consistent Presentation of Images Hardcopy and softcopy grayscale presentation state Key Image Notes Flag significant images Simple Image and Numeric Reports Simple reports with image links and, optionally, measurements Presentation of Grouped Procedures Subset a single acquisition Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Patient Information Reconciliation Unknown patients and unscheduled orders Integration Profiles Post- Processing Workflow Schedule, perform, & notify image processing & CAD steps Charge Posting Collection of billable procedure details

RSNA Simple Image & Numeric Reports Based on DICOM SRBased on DICOM SR Allows to include without transcription: - measurements - Image links - structured contentAllows to include without transcription: - measurements - Image links - structured content Integrated with the imaging workflowIntegrated with the imaging workflow Friendly to XML implementationsFriendly to XML implementations Easy to export to the CPR (HL7)Easy to export to the CPR (HL7)

RSNA Simple Image and Numeric Report Report content is more than words…..Report content is more than words….. With IHE, it is possible to add value to reporting with input from modalities and image processing applications (e.g. Measurements).With IHE, it is possible to add value to reporting with input from modalities and image processing applications (e.g. Measurements). This IHE Integration Profile is the cost effective solution for sharing reports and inclusion of image enabled reports into the Electronic Patient Record.This IHE Integration Profile is the cost effective solution for sharing reports and inclusion of image enabled reports into the Electronic Patient Record.

RSNA Problems How did Person X view MVP’s ankle images? How to maintain Clinical Use and Privacy – –authorized persons must have access to medical data of patients, and the information must not be disclosed otherwise. How to guarantee: – –Confidentiality – –Integrity – –Availability – –Authenticity The solution is……

RSNA Access to Radiology Information Consistent access to images and reports Consistent Presentation of Images Hardcopy and softcopy grayscale presentation state Key Image Notes Flag significant images Simple Image and Numeric Reports Simple reports with image links and, optionally, measurements Basic Security Audit Trail Consolidation & Node Authentication Presentation of Grouped Procedures Subset a single acquisition Post- Processing Workflow Schedule, perform, & notify image processing & CAD steps Charge Posting Collection of billable procedure details Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Patient Information Reconciliation Unknown patients and unscheduled orders Integration Profiles

RSNA Basic Security Profile AuditRecordRepository … Image Manager & Archive “Images Queried / Retrieved” Diagnostic Workstation Report Repository … Report & Image Review “Reports Queried / Retrieved” “Images Printed” “Reports Stored” “Reports Retrieved” “Reports Printed”

RSNA IHE Year 4 has a proposal for a basic set of Security functions definedIHE Year 4 has a proposal for a basic set of Security functions defined –User Log-on –Node Authentication –Audit Trail This targets the HIPAA requirement for Accountability and Access controlThis targets the HIPAA requirement for Accountability and Access control Is this sufficient for HIPAA in the Radiology imaging domain? Who decides?Is this sufficient for HIPAA in the Radiology imaging domain? Who decides? IHE Basic Security HIPAA-Readiness

RSNA See IHE actually implemented…. See the 30 min presentation to see these IHE Integration Profiles actually implementedSee the 30 min presentation to see these IHE Integration Profiles actually implemented Demonstrated by more than 30 vendors with more than 70 productsDemonstrated by more than 30 vendors with more than 70 products You check on the commercial exhibit, availability of IHE Integration Profile in products you may own or intend to acquireYou check on the commercial exhibit, availability of IHE Integration Profile in products you may own or intend to acquire IHE is HERE and NOW !

RSNA Where is More Information Available? IHE Technical framework for year 4 – V5.4 Non-Technical Brochures : IHE Primer and IHE FAQ IHE Integration Profiles: Guidelines for Buyers IHE Connectathon Results IHE Integration Statements from Vendors

RSNA Access to Radiology Information Consistent access to images and reports Consistent Presentation of Images Hardcopy and softcopy grayscale presentation state Key Image Notes Flag significant images Simple Image and Numeric Reports Simple reports with image links and, optionally, measurements Basic Security Audit Trail Consolidation & Node Authentication Presentation of Grouped Procedures Subset a single acquisition Post- Processing Workflow Schedule, perform, & notify image processing & CAD steps Charge Posting Collection of billable procedure details Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Patient Information Reconciliation Unknown patients and unscheduled orders Integration Profiles