1. IHE Radiology Scheduled Workflow for Import Peter Kuzmak, Cindy Levy, Dr. Ruth Dayhoff and Andrew Casertano November 2005

2. IHE Radiology Page 2 Problem Statement : Data importing from external sources Importing Institution Image Archive/ Image Manager Patient Data Patient Data on Removable Media Film, Paper Data Import There is a high level of frustration in the import and review of clinical data by importing institution providers. How do deal with outside identifiers, unknown patients, missing or misidentified data, referrals, non-standard formats, film, screen prints etc?

3. IHE Radiology Page 3 The Problem Described: References The US Department of Veterans Affairs, “Importing DICOM Objects from Portable Media into PACS – the VA Solution”, abstract accepted for SCAR 2006 Groningen University Hospital and ETIAM, The Netherlands, “Incorporating Out-Patient Data From CD-R Into the Local PACS Using DICOM Worklist Features”, Journal of Digital Imaging, Sept 2005 Groningen University Hospital The Netherlands, “A new outpatient with PACS data on CD, now what?”, presented at EuroPACS-MIR, 2004 University of Texas, Anderson Cancer Center of Texas, “Importation of CD-based Image Studies into PACS: Initial Experience”, presented at SCAR 2005. Existing Profiles such as Scheduled Workflow, Patient Reconciliation and Portable Data for Imaging are a great start but not a complete resolution.

4. IHE Radiology Page 4 IHE Solution What is Needed? Define minimum requirements to ensure that importing is as robust as acquisition through Scheduled Workflow. Patient Information Reconciliation must be integral to the importing process. Throughout the entire process, the ability to maintain the original attributes in the DICOM header so that one can trace the origin.

5. IHE Radiology Page 5 Actors Acquisition Modality (as hardcopy importer) Same as in current Radiology Framework with updated –Modality Procedure Step in Progress –Modality Images Stored Portable Media Importer Same as in current Radiology Framework with updated –Imported Procedure Step in Progress –Imported Images Stored Image Manager/ Image Archive Same as in current Radiology Framework with updated –Modality Procedure Step in Progress –Modality Images Stored –Imported Procedure Step in Progress –Imported Images Stored …

6. IHE Radiology Page 6 Transactions Updated Transactions Modality Worklist Provided -- Additional description of importing hardcopy Broad Worklist Query (Open issue) Modality Performed Procedure Step In Progress to include the importing of hardcopy data. Modified Performed Procedure Step Completed/Discontinued to include Import Modality Images Stored to include the importing of hardcopy data. New Transactions Import Performed Procedure Step In Progress to discuss the specific requirements for Imported DICOM Composite Objects on how data needs to be coherced in some cases and maintained from the original DICOM Composite Objects in other cases. Import Images Stored to discuss the specific requirements for Imported DICOM Composite Objects.

7. IHE Radiology Page 7 Use Case #1: Patient Known, Scheduled Order An institution contracts for a study to be performed externally outside the institution. The studies are ordered and performed externally. The images are read either inside or outside the institution. The images and results shall be placed in the patient’s EHR. An example of this might be an imaging study done at a commercial imaging center because the local medical center does not have the necessary equipment. Sometimes the institution only wants the images are on the CD and the institution wants its radiologists to interpret them. Other times the institution has the outside radiologists do the reading, and the CD comes with both the images and the corresponding reports.

8. IHE Radiology Page 8 Use Case #1 Workflow Patient Known, Order Placed 2 3 4 5 1. DICOM Modality Worklist 2. DICOM Imported PPS 3. DICOM Imported Store 4. DICOM Storage Commitment 5. DICOM Query/Retrieve 1 Report Image Archive Patient Data

9. IHE Radiology Page 9 Use Case #2: Patient Known, Unscheduled Order The patient is seen at a facility outside the RHIO and has examinations performed that were not ordered by RHIO practitioners. The patient presents to the provider with a CD that includes evidence documents. A RHIO practitioner determines that the results of these examinations are important for proper patient care and that the images and report need to be added to the EHR. A ‘historical’ order is placed to create the study on the HIS/RIS and the data is added to the EHR.

10. IHE Radiology Page 10 Use Case #2 Workflow 2 3 4 5 1. DICOM Modality Worklist 2. DICOM Imported PPS 3. DICOM Imported Store 4. DICOM Storage Committment 5. DICOM Query/Retrieve 1 Portable Media Importer Report Image Archive Patient Known, ‘Historical’ Order Placed Patient Data

11. IHE Radiology Page 11 Use Case #3: Patient not Known Patient information is delivered to a provider in advance of admission. The patient is not known to the RHIO. The provider is made aware that the patient information contained on the CD is not sufficient to register the patient. The provider wishes to view and interpret the images immediately and then later, add the patient and procedure information into the record. The provider places the data into a ‘temporary’ queue and puts the information ‘on the shelf’ until additional information has been made available.

12. IHE Radiology Page 12 Use Case #3 Workflow 2 3 4 5 1. DICOM Modality Worklist 2. DICOM Imported PPS 3. DICOM Imported Store 4. DICOM Storage Commitment 5. DICOM Query/Retrieve 1 Portable Media Importer Report Image Archive Patient Not Known, New Order Placed Patient Data

13. IHE Radiology Page 13 Use Case #4: Referral A patient is referred to a institution’s provider. The patient’s data arrives from the original organization via CD, paper and film. If the patient is not known, the provider must register the patient as a “Jane Doe”. Once the patient is registered, then an order is placed.

14. IHE Radiology Page 14 Use Case #5: Film Scanning An institution has a film scanning policy that imports a patient’s films on an as needed basis. Prior to a patient visit, a patient’s data is scanned into DICOM format. This data is made available for a provider to review and compare with incoming data.

15. IHE Radiology Page 15 In Scope / Out of Scope Below are the results of the group’s “what’s inscope of this work” discussion FeatureIn/Out Broad Worklist QueryIn AppendIn Film, Paper Import into DICOMIn Exception HandlingIn additional Security considerationOut ReportsOut Non-DICOM formatsOut Note: list functionality especially at borders of what is included/excluded – i.e., included features that could reasonably be descoped by the Technical Committee, or excluded features that could be included

16. IHE Radiology Page 16 Open Issues What’s my Name Performed Procedure Step Manager Modification to Volume II Appendix A Reports DICOM CP-526 Coordination with Cardio