1. Imaging Object Change Management (IOCM)
Kinson Ho – Architect, Agfa HealthCare

2. Problem Statement Patient movement during acquisition
Forgot about system default (e.g. LCC vs RCC)
Human error (e.g. select wrong worklist item)

3. Bad situations become worse
Problem Statement
Bad situations become worse

4. Value Proposition
When people make mistakes, patient safety is potentially compromised
In a distributed system, correction has to be propagated accordingly for proper timely and accurate patient care
Imaging Object Change Management profile provides
A change management communication protocol
that has well-defined scope,
is simple to understand
and least disruption
People makes mistake
Patient safety is potentially compromised
In a distributed system, correction has to be propagated accordingly in order to provide updated information for proper patient care

5. Use Cases Use Cases Quality Reason (e.g. Patient Movement)
Patient Safety Reason (e.g. Incorrect View Code)
Incorrect Worklist Selection
Data Retention Expiration
Continue to rely on existing mechanisms for other changes
Scheduled Workflow
Patient Information Reconciliation
Import Reconciliation Workflow

6. Design Principles (1) Reject and Replace
Improvement with least disruption
Smart Source
Regular Image Manager + Regular Display
Smart Image Manager + Regular Display
Regular Image Manager + Smart Display
Compatible with portable media and external publication

7. Design Principles (2) Use standard DICOM Key Object Selection Document
Reuse DICOM Storage, Query/Retrieve services
A unique Key Object Document Title for each use case
(113001, DCM, “Rejected for Quality Reasons”)
(113037, DCM, “Rejected for Patient Safety Reasons”)
(113038, DCM, “Incorrect Modality Worklist Entry”)
(113039, DCM, “Data Retention Policy Expired”)

8. High Level Data Flow (1)

9. High Level Data Flow (2)

10. Actor / Transaction Diagram (1)
Core actors related to Scheduled Workflow (SWF) and Import Reconciliation Workflow (IRWF)

11. Actor / Transaction Diagram (2)
Actors related to Portable Data for Imaging (PDI)

12. Actor / Transaction Diagram (3)
Actors related to Cross Enterprise Document Sharing for Imaging (XDS-I)

13. Key Requirements 5 classes of Actors Change Requester Image Manager
Importer / Exporter*
Change Consumer*
Department Scheduler System / Order Filler
* Not actual actor name

14. Key Requirements – Change Requester
Required to group with
Modality
Evidence Creator
Image Manager
Create Rejection Note
Create Replacement Instances
Metadata must be corrected
Match correct worklist
Match critical attributes

15. Key Requirements – Image Manager
Process Rejection Notes : Quality Reason
Configurable Behavior
Regular Use
Hide Rejected Instances in Query/Retrieve
Provide 2 AE Titles for each C-Find and C-Move
Configurable to restrict access to “Regular Use” AE

16. Key Requirements – Image Manager
Process Rejection Notes : Patient Safety or MWL Correction
Not provide this Rejection Note in Query/Retrieve/Store
Not provide rejected instances in Query/Retrieve/Store
Not accept subsequent occurrence of rejected instances
Process Rejection Notes : Data Retention Policy Expired
Delete the expired instances
Delete this Rejection Note
Accept subsequent occurrence of deleted instances

17. Key Requirements – Image Manager
Receive replacement instances
Send Instance Availability Notification to DSS/OF
Include all available
Status: ONLINE, NEARLINE or OFFLINE
Include rejected instances
Status: UNAVAILABLE
Special case for Rejection of Quality Reason
Hide rejected instances
Regular Use

18. Key Requirements – Importer / Exporter
Includes
Importer (IRWF)
Portable Media Creator, Portable Media Importer (PDI)
Imaging Document Source (XDS-I.b)
Exclude Rejection Note
Exclude rejected instances

19. Key Requirements – Change Consumer
Includes
Image Display (SWF or PDI)
Display, Report Reader, Print Composer (PDI)
Imaging Document Consumer (XDS-I.b)
Rejection: Quality Reason
Configurable behaviour for showing / hiding rejected instances and the rejection note
Rejection: Other 3 Reasons
No Rejection Note and rejected instances

20. Key Requirements – DSS / OF
Receives Instance Availability Notification from Image Manager
Specially important for Worklist Correction case
If the procedure step has no more available instances, then reset the status to Scheduled.

21. Next Step Review Trial Implementation of IOCM:
Sign-up to participate in IHE Connectathon in early 2014