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Integrating the Healthcare Enterprise

Integrating the Healthcare Enterprise. Presentation of Grouped Procedures. Charles Parisot, GE Healthcare IHE IT Radiology Planning and Technical Committees. IHE Integration profiles. Access to Radiology Information. Scheduled Workflow. Patient Informa-tion Reconci-liation. Charge Posting.

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Integrating the Healthcare Enterprise

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  1. Integrating the Healthcare Enterprise Presentation of Grouped Procedures • Charles Parisot, GE Healthcare • IHE IT Radiology Planning and Technical Committees IHE Interoperability Workshop

  2. IHE Integration profiles Access to Radiology Information Scheduled Workflow Patient Informa-tion Reconci-liation Charge Posting - Presentation of Grouped Procedures Reporting Workflow Post-Processing Workflow Simple Image and Numeric Reports Consistent Presentation of Images Evidence Documents Key Image Notes Basic Security IHE Interoperability Workshop

  3. IHE Integration profiles Access to Radiology Information Scheduled Workflow Patient Informa-tion Reconci-liation Charge Posting - Presentation of Grouped Procedures Reporting Workflow Post-Processing Workflow Simple Image and Numeric Reports Consistent Presentation of Images Evidence Documents Key Image Notes Basic Security IHE Interoperability Workshop

  4. IHE Scheduled Workflow Patient Registration/UpdateOrder Management Worklist Modality Worklist Procedure Scheduled Store Images StorageCommitment Storage Commitment List of Images Modality Performed Procedure Step Performed Step: Status = Completed Performed CT Head Pat Name/ID, Dose, Accession #, Study UID Complete List of Images RIS PACS &Archive • A Closed Loop • Update IS Scheduling • Match Procedure with Order • Support Billing Based on MPPS • Avoid Reading incomplete Procedures IHE Interoperability Workshop

  5. IHE Workflow Concepts IHE identifies four fundemental workflow information units : Procedure Steps :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’ ORDER : A request for radiologic service REQUESTED PROCEDURE : A Unit of Reporting Work with associated codified, billable acts

  6. IHE Workflow is User Driven CLINICIANOR REFERING DOC:The Imaging Dept Customer RADIOLOGIST : In Charge of producing theReport TECHNOLOGIST(and RADIOLOGIST)In charge of acquiring images, etc. Information Unit has its Prime User ORDER:A request for imaging service (Accession Number) REQUESTED PROCEDURE : Units of work resulting in one Reportwith associated codified, billable acts(Requested Procedure ID) PROCEDURE STEP :The smallest unit of workin the workflow (modality worklist entry)

  7. IHE Workflow is User Driven CLINICIANOR REFERING DOC:The Imaging Dept Customer RADIOLOGIST : In Charge of producing theReport TECHNOLOGIST(and RADIOLOGIST)In charge of acquiring images, etc. Information Unit has its Prime User ORDER:A request for imaging service (Accession Number) REQUESTED PROCEDURE : Units of work resulting in one Reportwith associated codified, billable acts(Requested Procedure ID) PROCEDURE STEP :The smallest unit of workin the workflow (modality worklist entry) IHE Interoperability Workshop

  8. Normal Workflow One or more series of images Typical workflow: One Order – One Procedure – One Report Radiology Department ORDER A request for RadiologicService Set of Codifiable, Billable, Acts Requested Procedure Report Acquisition Modality

  9. Multiple Modality Steps DICOMModality Worklist ScheduledProcedure Step A Report ScheduledProcedure Step B One or more series of images One or more series of images DICOMModality Worklist PerformedProcedure Step P1 PerformedProcedure Step P2 AcquisitionModality AcquisitionModality Radiology Department ORDER A request for RadiologicService Set of Codifiable, Billable, Acts Requested Procedure 1

  10. Multiple Modality Steps (Append) DICOMModality Worklist DICOMModality Worklist ScheduledProcedure Step A Report One or more series of images One or more series of images PerformedProcedure Step P1 PerformedProcedure Step P2 Radiology Department ORDER A request for RadiologicService Set of Codifiable, Billable, Acts Requested Procedure 1 AcquisitionModality

  11. Discontinued Procedure Step DICOMModality Worklist Set of Codifiable, Billable, Acts Requested Procedure 1 Report ScheduledProcedure Step A One or more series of images AcquisitionModality Requested Procedure 2 ScheduledProcedure Step C NoPerformedProcedure Step PerformedProcedure Step P1 Discontinue Radiology Department ORDER A request for RadiologicService

  12. IHE Interoperability Workshop

  13. The Group Case Approach One Order – Two Procedures – One Acquisition - Two Reports Step Requested Procedure CT Chest Requested Procedure CTAbdomen One or more series of images Radiology Department ORDER A request for RadiologicService CT Chest & Abdomen Set of Codifiable, Billable, Acts Report CT Chest Acquisition Modality Report CT Abdo Set of Codifiable, Billable, Acts

  14. Group Case DICOMModality Worklist Requested Procedure 1 ScheduledProcedure Step A Requested Procedure 2 ScheduledProcedure Step B One or more series of images PerformedProcedure Step P1 Radiology Department Set of Codifiable, Billable, Acts ORDER A request for RadiologicService Report Set of Codifiable, Billable, Acts Report AcquisitionModality

  15. Is Grouping of Procedures a common need ? • CT Chest/Abdomen/Pelvis • Neuroradiology: CT Neck & CT Chest • MR Imaging of different sections of the spine • MRI and MRA of vessels acquired together • MRI of the head and neck with specialized coils • Direct radiography (DR)in a trauma patient: AP images, then move the patient once to acquire a set of orthogonal images, and then regroup by body part • Sonographic evaluation of the kidneys and of the abdomen • CT of the pelvis with CT angiographic runoff • Angiographic studies of multiple vessels mixed with therapeutic interventions on selected segments. IHE Interoperability Workshop

  16. Why is the Grouping of Procedures a significant need ? • Optimize patient comfort • Optimize time of image acquisition. • Maintain the link back to each one of the grouped procedures without breaking the acquisition apart. • Ensure that each image subset related to a requested procedure is identified and ready to be presented. This is key for quick display of new and prior studies. • In the film world, images are manually sorted. In the film-less world, images should be sorted automatically when displayed But, there is the need to: IHE Interoperability Workshop

  17. Grouping of Procedures in IHE Group Case support is required by the IHE Scheduled Workflow Integration Profile on Image Managers (PACS) and Order Fillers (RIS). Its support is optional on Modalities. IHE Interoperability Workshop

  18. IHE Integration profiles Access to Radiology Information Scheduled Workflow Patient Informa-tion Reconci-liation Charge Posting - Presentation of Grouped Procedures Reporting Workflow Post-Processing Workflow Simple Image and Numeric Reports Consistent Presentation of Images Evidence Documents Key Image Notes Basic Security IHE Interoperability Workshop

  19. IHE Integration profiles Access to Radiology Information Scheduled Workflow Patient Informa-tion Reconci-liation Charge Posting - Reporting Workflow Post-Processing Workflow Presentation of Grouped Procedures Simple Image and Numeric Reports Consistent Presentation of Images Evidence Documents Key Image Notes Basic Security IHE Interoperability Workshop

  20. IHE Integration profiles Access to Radiology Information Scheduled Workflow Patient Informa-tion Reconci-liation Charge Posting - Reporting Workflow Post-Processing Workflow Presentation of Grouped Procedures Simple Image and Numeric Reports Consistent Presentation of Images Evidence Documents Key Image Notes Basic Security IHE Interoperability Workshop

  21. IHE Integration Profiles Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Presentation ofGrouped Procedures Presentation of Subsets of a Single Acquisition Required for ConsistentPresentation of Images Softcopy grayscale and presentation state + IHE Interoperability Workshop

  22. IHE – Presentation of Grouped Procedures Report:CHEST Report:ABDOMEN Abdomen View ScheduledProcedure Step Chest ScheduledProcedure Step Abdo Chest View Chest View Abdomen View Performs a single exam MODALITY Operator groups 2 procedures Requested Procedure:CHEST Requested Procedure:ABDOMEN RIS / PACS IHE Interoperability Workshop

  23. Presentation of Grouped Procedures Improves workflow, overall efficiency of care and reduces costs of providing services: • Lowers barriers to migration to digital radiology practice • Optimizes use of newer & faster acquisition devices • Improves clarity and access to Radiology results • Simplifies and facilitates billing of grouped procedures • Enhances softcopy interpretation throughput IHE Interoperability Workshop

  24. IHE Interoperability Workshop

  25. More information…. • IHE Web sites: http://www.rsna.org/IHE • Technical Frameworks: • RAD V5.5 • Technical Framework Supplements - Trial Implementation • May 2004: Radiology • 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 IHE Interoperability Workshop

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