1. IHE Workshop – June 2006What IHE Delivers 1 Kevin ODonnell Toshiba Medical Systems Scheduled Workflow: The First Profile

2. IHE Workshop – June 2006 2 Scheduled Workflow Scope Genesis 1: In the beginning, … [ or better yet ] Genesis 11: Tower of Babel and there confound their language, that they may not understand one another's speech.

3. IHE Workshop – June 2006 3 Scheduled Workflow Scope Backbone of IHE Radiology Integrates Registration, Scheduling, Acquisition Workflow and Image Content Bridges HL7 and DICOM Spaces

4. IHE Workshop – June 2006 4 Scheduled Workflow: Use Case Registration Orders Placed Orders Filled Film Folder Image Manager & Archive Film Lightbox report Report Repository Diagnostic Workstation Modality acquisition in-progress acquisition completed images printed Acquisition Modality

5. IHE Workshop – June 2006 5 Scheduled Workflow Value Proposition Preserve Order Continuity Close the Loop maintain accession number, avoid confusion with Filler #, Placer #, etc. Improve Demographic Integrity Data entry errors significant occurrence significant consequences Enter once, pass from system to system

6. IHE Workshop – June 2006 6 Scheduled Workflow Value Proposition Improve Workflow Efficiency Use of Worklists less time spent doing data entry/selection enables semi-automation of setup Reliable Storage Storage Commitment fewer lost studies more confidence in results

7. IHE Workshop – June 2006 7 Scheduled Workflow Value Proposition Improve Order Tracking MPPS from Modality to RIS & PACS more timely feedback more precise feedback Reduce Integration Effort at Site Get Vendors on the Same Page Provide Implementation Guidance Pre-test at Connectathon

8. IHE Workshop – June 2006 IHE Workflow Concepts PROCEDURE STEP : 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 has selected three UNAMBIGUOUS TERMS : IHE has selected three UNAMBIGUOUS HL7/DICOM TERMS : ORDER : A request for radiologic service ORDER : A request for radiologic service REQUESTED PROCEDURE : A Unit of work resulting in one Report (with associated codified, billable acts) REQUESTED PROCEDURE : A Unit of work resulting in one Report (with associated codified, billable acts)

9. IHE Workshop – June 2006 Workflow Concept Mapping This 3 level workflow structure is user oriented: 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.

10. IHE Workshop – June 2006 Acquisition Modality Normal Workflow ORDER A request for Radiologic Service Radiology Department Set of Codifiable, Billable, Acts One or more series of images Performed Procedure Step Requested Procedure Scheduled Procedure Step Report DICOM Modality Worklist Typical workflow: One Order – One Procedure – One Report

11. IHE Workshop – June 2006 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

12. IHE Workshop – June 2006 12 Scheduled Workflow HL7 Actors & Transactions HL7 Actors: ADT/Patient Registration Order Placer DSS / Order Filler Image Manager

13. IHE Workshop – June 2006 13 Scheduled Workflow Standards Used HL7 V2.3.1 Patient Registration Admit: A01 (In Patient), A04 (Out Patient), A05 (Pre-Admission) Cancel: A11 (Cancel Admit), A38 (Cancel Preadmit) Patient Update Transfer: A02 (Patient Transfer) Update Patient Class: A03 (Discharge), A06(Outpatient becomes Inpatient), A07 (Inpatient becomes Outpatient) Update Patient Information: A08 (Update) Merge Patients: A40 (Merge) Cancel: A12 (Cancel Transfer), A13 (Cancel Discharge)

14. IHE Workshop – June 2006 14 Scheduled Workflow Standards Used HL7 V2.3.1 Order Management New Order: ORM/NW & ORM/SN (New Order) Order Status: ORM/SC (Status Change) Cancel: ORM/CA, ORM/DC & ORM/OC (Cancel Order) Procedure Details Scheduled: ORM (Procedure Scheduled) Updated: ORM (Procedure Updated)

15. IHE Workshop – June 2006 15 Scheduled Workflow DICOM Actors & Transactions DICOM Actors: DSS / Order Filler PPS Manager Image Manager / Archive Acquisition Modality Evidence Creator Image Display

16. IHE Workshop – June 2006 16 Acquisition Workflow Management DICOM: Modality Worklist Management (MWL) Modality Performed Procedure Step (MPPS)

17. IHE Workshop – June 2006 17 Image Management DICOM: Image Storage Storage Commitment Query/Retrieve

18. IHE Workshop – June 2006 18 Additional Workflow Management HL7: ORM Message DICOM: Query (C-FIND) Modality Performed Procedure Step (MPPS)

19. IHE Workshop – June 2006 19 Patient Information Reconciliation Expect the Unexpected

20. IHE Workshop – June 2006 20 Patient Information Reconciliation Abstract / Scope Extension of Scheduled Workflow Coordinated update of demographic information in workflow and content objects

21. IHE Workshop – June 2006 21 Patient Information Reconciliation Value Proposition Handle exception cases Trauma/Emergent Cases Patient Unknown or no time for Registration Entry Errors by Operator Other Demographic Changes (e.g. married name) Multiple sources/destinations for updates High risk of unsynchonized/inconsistent data Workflow must continue Need to pull together past & current patient records

22. IHE Workshop – June 2006 22 Use Cases Local policy calls for ADT to pre-register ER patients (John Doe, Jane Doe): Case 1: Unidentified Patient registered at ADT and order is placed at Order Placer. Case 2: Unidentified Patient registered at ADT and order is placed at DSS/Order Filler. Case 3: Unidentified Patient registered at ADT but acquisition completed at Modality prior to order.

23. IHE Workshop – June 2006 23 Use Cases Local policy allows departments to register ER patients with Departmental IDs: Case 4: Unidentified Patient assigned temporary Departmental ID and scheduled at DSS/Order Filler. Case 5: Image Acquisition completed prior to assigning temporary Departmental ID or Order (Patient ID entered at the Modality).

24. IHE Workshop – June 2006 24 Patient Information Reconciliation Transaction Diagram

25. IHE Workshop – June 2006 25 Emergency - Case 3 ADT Order Placer Image Manager Modality Department System Database/Scheduler/ Order Filler Filler Order Mgmt New Order [3] Procedure Scheduled [4] Patient Reconciliation J.Doe ->J.Smith Patient Update [12] Schedule Procedure Images Acquired ModalityProcedure Step Completed [7] Modality Procedure Step Completed [7] RegisterJ.Doe Patient Update [12] Patient Registration [1]

26. IHE Workshop – June 2006 26 More information…. IHE Web site: www.ihe.net www.ihe.net Technical Frameworks & Supplements Non-Technical Brochures : Calls for Participation IHE Fact Sheet and FAQ IHE Integration Profiles: Guidelines for Buyers IHE Connect-a-thon Results Vendor Product Integration Statements

27. IHE Workshop – June 2006 27