Integrating the Healthcare Enterprise

1. Integrating the Healthcare Enterprise Presentation of Grouped Procedures • Charles Parisot, GE Healthcare • IHE IT Radiology Planning and Technical Committees IHE - Effective Integration of the Enterprise and the Health System

2. Agenda • Scheduled Workflow: Refresher on critical workflow concepts • Scheduled Workflow:Refresher on well identified workflow cases • Presentation of Grouped Procedures:Taking the Group Case a step further • What should I do as an implementer ?Taking advantage of the new Appendix A IHE - Effective Integration of the Enterprise and the Health System

3. 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 - Effective Integration of the Enterprise and the Health System

4. IHE Workflow Concepts IHE identifies four fundamental 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 IHE - Effective Integration of the Enterprise and the Health System

5. 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 - Effective Integration of the Enterprise and the Health System

6. 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 IHE - Effective Integration of the Enterprise and the Health System

7. 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 IHE - Effective Integration of the Enterprise and the Health System

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9. 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 IHE - Effective Integration of the Enterprise and the Health System

10. 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 IHE - Effective Integration of the Enterprise and the Health System

11. 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 - Effective Integration of the Enterprise and the Health System

12. 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 - Effective Integration of the Enterprise and the Health System

13. Grouping of Procedures in IHE • Group Case support is required by the IHE Scheduled Workflow Integration Profile: • On Image Managers (PACS) • On Order Fillers (RIS). • Group Case support is optional on Modalities. • PGP requires support of the “Group Case Option” on Modalities. IHE - Effective Integration of the Enterprise and the Health System

14. PGP Integration Profilebuilds upon SWF and CPI 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 - Effective Integration of the Enterprise and the Health System

15. 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 acquisition MODALITY Operator groups 2 procedures Requested Procedure:CHEST Requested Procedure:ABDOMEN RIS / PACS IHE - Effective Integration of the Enterprise and the Health System

16. 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 - Effective Integration of the Enterprise and the Health System

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18. IHE PGP - Implementation Example Image Display Constraints Report:CHEST Report:ABDOMEN CPI only Actor Abdomen View Abdomen View ScheduledProcedure Step Chest ScheduledProcedure Step Abdo Image Display Chest View Chest View Chest View Abdomen View MODALITY Operator groups 2 procedures PGP Actors Requested Procedure:CHEST Requested Procedure:ABDOMEN Image Mgr (Incl. Display) Order Filler Image Displayhas no access to fullRequested Procedure Information Performs a single acquisition IHE - Effective Integration of the Enterprise and the Health System

19. Implementing PGP made easy ! • Feedback from early implementors has resulted in significant improvement for the Technical Framework: • Appendix A has been entirely restructured to provide a thorough and unambiguous specifications of all SWF+PGP workflow cases. • The NewAppendix A defines precisely every details for information mappings in modalities between MWL, Images/Presentation States, Modality PPS. This is critical information for PACS and RIS implementations of SWF and PGP. IHE - Effective Integration of the Enterprise and the Health System

20. W W W . . N E T Technical Frameworks:www.ihe.net/TF Connectathon results:www.ihe.net/CNCT Vendors Integration Statements:www.ihe.net/IS Sponsors Web sites:www.ihe.net/SPR Chapters World-wide:www.ihe.net/WORLD Questions? IHE - Effective Integration of the Enterprise and the Health System

21. W W W . I H E . N E T Providers and Vendors Working Together to Deliver Interoperable Health Information Systems in the Enterprise and Across Care Settings IHE - Effective Integration of the Enterprise and the Health System