Integrating the Healthcare Enterprise

1. Integrating the Healthcare Enterprise – Radiology – Established IHE Integration Profiles: • Post-Processing Workflow (PPWF) • Dr. Nikolaus Wirsz – Siemens Medical Solutions IHE Europe Committee IHE Radiology Planning Committee IHE Europe Workshop

2. IHE Radiology Integration Profiles Charge Posting Presentation of Grouped Procedures Reporting Workflow KeyImageNotes Simple Image & Numeric Reports NMImage Consistent Present-ation of Images EvidenceDocs Access to Radiology Information Portable Data for Imaging Scheduled Workflow - Patient Info. Recon-ciliation Post-Processing Workflow (PPWF) Basic Security IHE Europe Workshop

3. Summary • Extension to the Scheduled Workflow to SupportTypical Post-Processing Workflow Procedures: • Image Processing • Image Reconstruction • Computer Aided Detection • Ability to Schedule and Track the Status of Post-Processing Tasks IHE Europe Workshop

4. IHE Post-Processing Workflow Overview RIS Work Item Claimed Departmental System Scheduler Order Filler Completed Post-ProcessingWorklist Post-Processing Procedure Step STARTED RetrieveImages Store Reports Measurements CAD Reports ……....……… Archive Images Post-Processing Procedure Step STARTED 3D Workstation PACS & Archive Image & Post-Proc. Manager Post-Processing Procedure Step COMPLETED Post-Processing Procedure Step COMPLETED IHE Europe Workshop

5. DICOMModality Worklist ScheduledProcedure Step A Report ScheduledProcedure Step B One or more series of images One or more series of images DICOMPost-Processing Worklist M-Perf.Procedure Step P1 PP-Perf.Procedure Step P2 Post-Processing AcquisitionModality Modality and Post-Processing Steps Radiology Department ORDER A request for RadiologicalService Set of Codifiable, Billable Acts Requested Procedure 1 IHE Europe Workshop

6. PPWF Actors & Transactions • Additional Actor: • Post-Processing Manager • Transactions: • Worklist Provided • Workitem Claimed • Workitem PPS In Progress • Workitem PPS Completed • Workitem Completed • Performed Work Status Update • Evidence Documents Stored • Query Evidence Documents • Retrieve Evidence Documents IHE Europe Workshop

7. Post-Processing Manager Grouping • Either with Image Manager (PACS) Performed Work Status Update (optional) DSS/OF Post-Processing Manager IM/IA IHE Europe Workshop

8. Post-Processing Manager Grouping • Or with Departmental System Scheduler / Order Filler (RIS) Performed Work Status Update IM/IA Post-Processing Manager DSS/OF IHE Europe Workshop

9. Actors and Transactions Query Images Retrieve Images Query Evidence Documents Retrieve Evidence Documents Evidence Documents Stored Images Stored Storage Commitment Performed Work Status Update Worklist Provided Image Availability Query Workitem Claimed Workitem PPS In Progress Workitem PPS Completed Workitem Completed IM/IA Image Display Evidence Creator Post-Processing Manager DSS/OF IHE Europe Workshop

10. Worklist Provided • EvidenceCreator finds out what post-processing tasks have been scheduled or assigned to it by the Post-Processing Manager • Worklist provided for workitem codes e.g. Image Processing or Computer Aided Detection. • Evidence Creator includes received information in the resulting instances IHE Europe Workshop

11. Worklist Provided C-FIND-RQ • General Purpose Worklist SOP Class • Explicit definition of required matching and return keys for both Post-Processing Manager and Evidence Creator • Evidence Creator shall implements at least one of 3 query cases: • Patient Oriented Query: Worklist for a specific patient / procedure • Station Oriented Query: Broad Worklist for a particular workstation • Class Oriented Query: Broad Worklist for a class of workstations (e.g. workstations for CT 3D Reconstructions) Post-Processing Manager Evidence Creator C-FIND-RSP IHE Europe Workshop

12. Workitem Claimed • Evidence Creator takes ownership of the workitem • Post-Processing Manager updates its worklist and permits other worklist users to detect that this SPS has been claimed IHE Europe Workshop

13. Workitem Claimed • General Purpose Scheduled Procedure Step SOP Class Evidence Creator Post-Processing Manager N-ACTION (SPS in Progress) IHE Europe Workshop

14. Workitem PerformedProcedure Step In Progress • Evidence Creator starts work on claimed SPS • Notifies Post-Processing Manager to create a Performed Procedure Step IHE Europe Workshop

15. Workitem PerformedProcedure Step In Progress • General Purpose Performed Procedure Step SOP Class • SPS and PPS relationships (Appendix III-D): • Simple Case • Unscheduled Case • Append Case • Abandoned Case Evidence Creator N-CREATE(PPS in Progress) Post-Processing Manager IHE Europe Workshop

16. Workitem PerformedProcedure Step Completed • Evidence Creator notifies Post-Processing Manager of the PPS completion • Evidence Creator references any results created e.g. images, evidence documents IHE Europe Workshop

17. Workitem PerformedProcedure Step Completed • General Purpose Performed Procedure Step SOP Class • Evidence Creator shall send to the Post-Processing Manager a list of all Composite SOP Instances in the Output Information Sequence (0040,4033) Evidence Creator N-SET (PPS Completed) Post-Processing Manager IHE Europe Workshop

18. Workitem Completed • Evidence Creator notifies the Post-Processing Manager when it completes the scheduled workitem • Post-Processing Manager updates its worklist IHE Europe Workshop

19. Workitem Completed • General Purpose Scheduled Procedure Step SOP Class • No further PPS will be created for this SPS Evidence Creator N-ACTION (SPS Completed) Post-Processing Manager IHE Europe Workshop

20. Performed Work Status Update • Department System Scheduler and Image Manager inform each other of the status of performed post-processing work • Allows the system not managing the performed work to stay in sync IHE Europe Workshop

21. Performed Work Status Update • General Purpose Performed Procedure Step SOP Class N-CREATE (PPS in Progress) IM/IA DSS/OF N-SET (PPS Completed) N-CREATE (PPS in Progress) DSS/OF IM/IA N-SET (PPS Completed) IHE Europe Workshop

22. DICOM PP-PPS DICOM PP-PPS DICOM MPPS DICOM Image Storage DICOM Storage CommitmentDICOM MPPS DICOM Storage & Commitment DICOMPP-WL DICOM Storage & Commitment DICOM MWL DICOMPP-SPS DICOMQ/R DICOMPP-SPS DICOMQ/R DICOMPP-WL DICOM PP-PPS DICOMPP-PPS Wrap UpPost-Processing Workflow (Multiple Steps)with Post-Processing Manager grouped with Image Manager PACS RIS Modality Post-ProcessingStation CAD Station IHE Europe Workshop

23. Value Proposition • Improve Post-Processing Workflow Efficiency –Use of Worklists to Manage Post-Processing Tasks • Eliminate Errors Associated with Paper and Film Handling • Close the Information Loop: • Integrating Post-Processing Results with Acquired Images • Associate Post-Processing Results with Correct Order • Enable Sub-sequent Workflow Steps: • Initiate Reporting Workflow • Support for Billing Based on Post-Processing Results IHE Europe Workshop

24. Questions ? References:IHE Europe: http://www.IHE-Europe.org IHE Main Web Site: http://www. IHE.net IHE Europe Workshop