1. IHE Workshop – February 2007 What IHE Delivers 1 Credits for many slides to: Cynthia A. Levy, Cedara Software IHE Technical Committee Import Reconciliation Workflow Profile Peter Mildenberger University Hospital Mainz DRG, ESR, DSC Marco Eichelberg OFFIS IHE – D Technical Manager

2. IHE Workshop – February 2007 2 Import Reconciliation Workflow Clinical Background Documentation and Imaging digital (HIS/RIS/PACS) Transfer of informations with film, CD, … Availability of these informations at different points, like OP, ICU, ED, Radiology… Many Films and CDs each day in all institutions  Uncoordinated workflow  Time consuming if physicians handle the media themselves handle the media themselves

3. IHE Workshop – February 2007 3 Import Reconciliation Workflow Problem Issues Physical Limitations  Security/Administrative: no CD drive in medical workstations Logistical Limitations  Portable Data may include different user interfaces in viewers, some viewers don’t work  The clinician’s need to archive images temporary or permanent can’t be fulfilled  Images not available in Radiology PACS for comparison or second- opinion consult Data Limitations  Patient not registered in the HIS  Patient not registered in the RIS

4. IHE Workshop – February 2007 4 Import Reconciliation Workflow Use Case – External Acquisition/Read Radiology Enterprise A Radiology Enterprise B Provider A Radiology Site B PACS A Portable Data Creator Patient Data 2. Radiology Site B creates portable media with patient images and/or Reports 1. Provider A orders External Radiology Procedure 3. Portable Media is sent to Reading Site A via CD. Patient Data is imported and read. 4. Study Results sent to Provider Radiologist PDI Disk

5. IHE Workshop – February 2007 5 Radiology Enterprise B Radiology Enterprise A PACS B Portable Data Creator Patient Data 2.Relevant Data (including film) is collected and Enterprise A creates portable media with patient’s radiology information. 1. Request for Patient’s case data to be transferred from Enterprise A to B. 3.Data is transported to Site B via CD. Patient Demographics are reconciled and data is imported into archive. 4. Patient Data is now associated with B’s electronic health record system. Import Reconciliation Workflow Use Case – Patient Referral/Transfer

6. IHE Workshop – February 2007 6 Import Reconciliation Workflow Value proposition Reading and Care Planning Efficiency: easy, dispersed, in context, access to patient’s data with the familiar user interface by all physicians in the healthcare enterprise. Reduced Cost: no need for training to use new viewers. Quality/Safety: patient and image identifiers are available and consistent Handling Efficiency: reduced handling effort in the patient’s data for importing process.

7. IHE Workshop – February 2007 7 Import Reconciliation Workflow Scope Import Reconciliation Workflow (IRWF) piggy-backs on Scheduled Workflow (SWF) Import of Evidence Objects regardless of transport mechanism  Hardcopy Import (e.g. Films, Documents)  Existing Evidence Objects (e.g. CDs, Network) Improved Demographic Integrity  Enterprise Patient/Order Information is used to identify the Evidence Objects  Original Patient Demographics are preserved within resultant Evidence Objects

8. IHE Workshop – February 2007 8 Import Reconciliation Workflow Requirements Patient must be registered in the HIS  Patient Demographics from the Enterprise must be used to reconcile imported data Import may be a Scheduled Order  Order information may be used to schedule the import  Order information may be used to reconcile imported data Import may be Unscheduled

9. IHE Workshop – February 2007 9 Import Reconciliation Workflow Out of Scope Unregistered Patient This scenario requires proper Patient Registration occur in all of the relevant Systems – HIS, RIS, PACS…

10. IHE Workshop – February 2007 10 Import Reconciliation Workflow Actors/Groupings IRWF introduces one new Actor - Importer The Importer is transport independent, and may need to be grouped:  Portable Media Importer may be grouped with the Importer to complete the import of Evidence Objects from a PDI CD  No grouping is necessary to import Films using a Digitizer.

11. IHE Workshop – February 2007 11 Import Reconciliation Workflow Options – and Not The Importer must implement at least one of the following options  Scheduled Import  Unscheduled Import Additionally, the Importer may support  Billing and Material Management But  Import PPS messages (esp. Exception Management) are required in IRWF

12. IHE Workshop – February 2007 12 Import Reconciliation Workflow Scheduled Import Option

13. IHE Workshop – February 2007 13 Import Reconciliation Workflow Scheduled Import Scheduled Import Option supports scheduling of the import. The DICOM Modality Worklist provides information to the Importer about:  Enterprise Patient Demographics Critical Attributes such as the Patient Name, Patient ID, Patient Birth Date and Patient Sex Other Patient Ids should be a merge of the Enterprise and Imported Object  Enterprise Order Information Critical Attributes such as the Accession Number

14. IHE Workshop – February 2007 14 Import Reconciliation Workflow Transaction used for Scheduled Import RAD-5 Query Modality Worklist provides Patient Demographics and Order information for Scheduled Import and has been enhanced to include  Scheduled Procedure Step Description may include instructions on what should be imported  Scheduled Procedure Sequence may include instructions on the subsequent use of the instances

15. IHE Workshop – February 2007 15 Import Reconciliation Workflow Scheduled Import Dependencies IRWF depends on Scheduled Workflow Required Actors for Scheduled Import are:  Department Scheduler System/Order Filler  Image Manager/Image Archive  Performed Procedure Step Manager  Importer

16. IHE Workshop – February 2007 16 Import Reconciliation Workflow Scheduled Import Transaction Diagram

17. IHE Workshop – February 2007 17 Import Reconciliation Workflow Scheduled Import Workflow Diagram

18. IHE Workshop – February 2007 18 Import Reconciliation Workflow Unscheduled Import Option

19. IHE Workshop – February 2007 19 Import Reconciliation Workflow Unscheduled Import Unscheduled Import Option supports ad hoc importing. An HL7 Patient Demographics Supplier provided to the Importer about Patient Demographics:  Critical Attributes such as the Patient Name (PID:5), Patient ID (PID:3), Patient Birth Date (PID:7) and Patient Sex (PID:8)  Other Patient Ids (PID:4) should be a merge of the Enterprise and Imported Object ITI-21 Patient Demographic Query provides Patient Demographics for Unscheduled Import

20. IHE Workshop – February 2007 20 Import Reconciliation Workflow Unscheduled Import Dependencies IRWF depends on Scheduled Workflow IRWF depends on IT Infrastructure Patient Demographics Query for Unscheduled Import Required Actors for Unscheduled Import are:  Patient Demographics Supplier  Image Manager/Image Archive  Performed Procedure Step Manager  Importer

21. IHE Workshop – February 2007 21 Import Reconciliation Workflow Unscheduled Import Transaction Diagram

22. IHE Workshop – February 2007 22 Import Reconciliation Workflow Unscheduled Import Workflow Diagram

23. IHE Workshop – February 2007 23 Import Reconciliation Workflow With IRWF, Data Reconciliation is done as part of the Process

24. IHE Workshop – February 2007 24 Import Reconciliation Workflow Import Critical Attributes Critical Patient Demographics and Order Information Attributes come from the Enterprise Critical Study attributes must be maintained from the Imported Objects including:  Study Instance UID (when valid)  Referenced Study Sequence  Scheduled Protocol Code Sequence

25. IHE Workshop – February 2007 25 Import Reconciliation Workflow Import Attribute Difference The actual mapping of attributes into the Resultant IODs and the MPPS depends upon the scenario:  Digitized Evidence Objects such as Films will need to be provided Study Instance UIDs and may not contain Original Patient Demographics (unless manually provided)  Digital Evidence Objects imported using Scheduled import may contain difference in the Resultant IODs versus the MPPS  And more… See RAD-TF:2 Appendix A for all Attribute Mapping

26. IHE Workshop – February 2007 26 Import Reconciliation Workflow Original Import Attributes All Attributes modified during the Import shall be maintained using Original Attribute Sequence A new Original Attribute Sequence is added every time DICOM objects are imported. Original attributes from digitized hardcopy may be manually entered.

27. IHE Workshop – February 2007 27 Import Reconciliation Workflow Contributing Equipment Attributes The Contributing Equipment Sequence is used to maintain information about the Importing Equipment.  Type of Equipment used to perform the import  Institution performing the import …

28. IHE Workshop – February 2007 28 Import Reconciliation Workflow Common IRWF Transactions The following transactions are required to complete the import:  RAD-59 Import Procedure Step In Progress is used to indicate that a Import is in-progress  RAD-60 Import Procedure Step Completed is used to indicate that a Import has been completed  RAD-61 Imported Objects Stored is used to store the Imported Evidence Objects  RAD-10 Storage Commitment ensures Imported Objects are stored

29. IHE Workshop – February 2007 29

30. IHE Workshop – February 2007 30 Import Reconciliation Workflow Common IRWF Transactions

31. IHE Workshop – February 2007 31 Import Reconciliation Workflow Common IRWF Transactions