1. Sept 13-15, 2004IHE Interoperability Workshop 1 Integrating the Healthcare Enterprise Reporting Workflow Key Image Notes Evidence Documents Rita Noumeir, PhD IHE Radiology Planning Committee

2. Sept 13-15, 2004IHE Interoperability Workshop 2 IHE Integration Profiles Scheduled Workflow Admit, order, schedule, manage worklists, track status, perform & notify acquisition related steps, create, store, manage, retrieve & use images Simple Image and Numeric Reports Create, store, manage, retrieve & use simple diagnostic reports with optional image links & measurements Evidence Documents Create, store, manage, retrieve & use objects to record study evidence Charge Posting Collect and post timely billable procedure details triggers Key Image Notes Create, store, manage, retrieve & use objects to flag significant images Reporting Workflow Manage worklists, track status, perform & notify diagnostic reporting steps Required for workflow management Required for content Images or ED required for content

3. Sept 13-15, 2004IHE Interoperability Workshop 3 Reporting Workflow Mechanisms Worklists for managing reporting tasks Tasks include references to images and evidence documents to be interpreted Status tracking of reporting tasks

4. Sept 13-15, 2004IHE Interoperability Workshop 4 PACS & Report Mgr RIS Reporting Workflow with Report Manager Grouped with Image Manager Reporting Worklist Retrieve Images Reporting Procedure Step STARTED Work Item Claimed Reporting Procedure Step STARTED Reporting Procedure Step COMPLETED Reporting Procedure Step COMPLETED IssueReports StoreReport Diagnostic Reports ……....………

5. Sept 13-15, 2004IHE Interoperability Workshop 5 Actors & Transactions Report Manager Report Creator/ Reader IM/IA PPS Manager DSS/OF Reporting Worklist Provided Workitem Claimed MPPS Completed Image Availability Procedure Scheduled Procedure Update P. Work Status Update Workitem PPS in Progress Workitem PPS Completed Workitem Completed

6. Sept 13-15, 2004IHE Interoperability Workshop 6Grouping Report Manager grouped with Image Manager Report Manager IM/IA DSS/OF Performed Work Status Update (optional) RWF Profile SWF Profile

7. Sept 13-15, 2004IHE Interoperability Workshop 7Grouping Report Manager grouped with DSS/OF Report Manager IM/IADSS/OF RWF Profile SWF Profile Performed Work Status Update, if needed

8. Sept 13-15, 2004IHE Interoperability Workshop 8Grouping Report Manager not grouped with neither IM nor DSS Report Manager IM/IA DSS/OF Performed Work Status Update RWF Profile SWF Profile Performed Work Status Update, if needed

9. Sept 13-15, 2004IHE Interoperability Workshop 9 Reporting Tasks Interpretation Interpretation and dictation Transcription Verification Review Comparison Coding

10. Sept 13-15, 2004IHE Interoperability Workshop 10 Transaction Description

11. Sept 13-15, 2004IHE Interoperability Workshop 11 Reporting Worklist Report Creator finds out what tasks have been scheduled

12. Sept 13-15, 2004IHE Interoperability Workshop 12 Reporting Worklist General Purpose Worklist SOP Class Explicit definition of required matching and return keys for both Report Manager and Report Creator Report Creator implements at least one of Patient Oriented or User Oriented queries Report Manager Report Creator C-Find-RQ C-Find-RSP

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

14. Sept 13-15, 2004IHE Interoperability Workshop 14 User Oriented Query Broad worklist for a particular user being logged in on a particular station SCU must support all combinations of 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 Scheduled Human Performers Sequence >Human Performer Code Sequence >>Code Value >>Coding SchemeDesignator >Human Performer’s Name

15. Sept 13-15, 2004IHE Interoperability Workshop 15 Reporting Workitem Codes DCMR CID 9231

16. Sept 13-15, 2004IHE Interoperability Workshop 16 Reporting Workitem Codes What is scheduled  GP Worklist: scheduled workitem code sequence What is performed  GP PPS: performed workitem code sequence What is next  GP PPS: requested subsequent workitems code sequence Codes are used to define:

17. Sept 13-15, 2004IHE Interoperability Workshop 17 Input Availability Report Manager uses Image Availability Query to know when images are available. Report Manager and Report Creator must be able to handle workitems with PARTIAL Image Availability in a stable way.

18. Sept 13-15, 2004IHE Interoperability Workshop 18 Input Information Report Creator may retrieve Input Objects using Input Information Sequence provided in the worklist response. Report Manager Report Creator C-Find-RQ C-Find-RSP IM/IA Retrieve Images, Evidence Documents

19. Sept 13-15, 2004IHE Interoperability Workshop 19 Workitem Claimed Report Creator takes ownership of the workitem Report Manager updates its worklist Report Manager Report Creator N-ACTION, GP-SPS in Progress

20. Sept 13-15, 2004IHE Interoperability Workshop 20 Workitem Performed Procedure Step In Progress Report Creator starts working on the workitem Report Manager Report Creator N-CREATE, GP-PPS in Progress

21. Sept 13-15, 2004IHE Interoperability Workshop 21 Workitem Performed Procedure Step Completed Report Creator finishes working on the workitem Report Creator  references any created results  may carry out several steps at once, tells the Report Manager what reporting tasks have been performed  may suggest subsequent workitems to the Report Manager Report Manager Report Creator N-CREATE, GP-PPS Completed

22. Sept 13-15, 2004IHE Interoperability Workshop 22 Workitem Completed Report Creator releases ownership of the workitem Report Manager updates its worklist Report Manager Report Creator N-ACTION, SPS Completed

23. Sept 13-15, 2004IHE Interoperability Workshop 23 Performed Work Status Update Report Manager informs other actors of the creation and status update of the performed reporting task Allows the systems not managing the performed work to stay in sync

24. Sept 13-15, 2004IHE Interoperability Workshop 24 Performed Work Status Update General Purpose Performed Procedure Step SOP Class Performed Workitem Code Sequence Requested Subsequent Workitem Code Sequence Report Manager DSS/OF IM/IA N-CREATE, PPS in Progress N-SET, PPS Completed

25. Sept 13-15, 2004IHE Interoperability Workshop 25 Diagnostic Reporting Use Cases Predefined report Workitem deferred Direct report creation Interpretation and dictation Transcription Partial completion Verification

26. Sept 13-15, 2004IHE Interoperability Workshop 26 Predefined report The user chooses a report from a list of pre-configured draft reports The results are normal I will also verify the report

27. Sept 13-15, 2004IHE Interoperability Workshop 27 Task deferred The user selects the task and decides not to perform it Put this task back on the worklist.

28. Sept 13-15, 2004IHE Interoperability Workshop 28 Partial Completion The user begins the task and then decides that this task cannot be completed at this moment Bad data quality! New acquisition is required

29. Sept 13-15, 2004IHE Interoperability Workshop 29Verification The user may need to correct the report's content by dictation Send report back to the transcriptionist for correction

30. Sept 13-15, 2004IHE Interoperability Workshop 30 Evidence Documents ….. Findings: Image Refs.: Header : Report Type: OB / Gyn BPD... ….. Evidence Document Stored Storage Commitment Query / Retrieve

31. Sept 13-15, 2004IHE Interoperability Workshop 31 Evidence Documents Measurements and coded data  DICOM SR document Created by either Acquisition Modality or Evidence Creator Produced during acquisition or post- processing workflows Interpreted along with the images

32. Sept 13-15, 2004IHE Interoperability Workshop 32 Evidence Documents Examples Mammography CAD Chest CAD OB-Gyn Ultrasound Measurements Vascular Ultrasound Measurements Vascular Intervention Results Echocardiography Measurements

33. Sept 13-15, 2004IHE Interoperability Workshop 33 Interpretation ….. Findings: Image Refs.: Header : Report Type: OB / Gyn BPD... ….. Simple Image & Numeric Report Evidence Documents ….. Findings: Image Refs.: Header : Report Type: OB / Gyn BPD... ….. Radiology Report Impressions : Gestational Age... Key Image Notes

34. Sept 13-15, 2004IHE Interoperability Workshop 34 More information…. IHE Web sites: http://www.himss.org/IHE http://www.rsna.org/IHE http://www.acc.org/quality/ihe.htmhttp://www.acc.org/quality/ihe.htm. 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