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Scheduled Workflow: The First Profile

Scheduled Workflow: The First Profile. Kevin O’Donnell Toshiba Medical Systems. 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. “.

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Scheduled Workflow: The First Profile

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  1. Scheduled Workflow:The First Profile Kevin O’Donnell Toshiba Medical Systems

  2. Scheduled WorkflowScope • 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. Scheduled WorkflowScope • Backbone of IHE Radiology • Integrates Registration, Scheduling, Acquisition Workflow and Image Content • Bridges HL7 and DICOM Spaces

  4. Scheduled Workflow: Use Case report Registration Film Lightbox Image Manager & Archive Orders Filled Film Folder Diagnostic Workstation Film Report Repository Orders Placed AcquisitionModality acquisitioncompleted acquisitionin-progress imagesprinted Modality acquisitioncompleted

  5. Scheduled WorkflowValue 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. Scheduled WorkflowValue 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. Scheduled WorkflowValue 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 Workflow Concepts IHE has selected three UNAMBIGUOUS HL7/DICOM TERMS : 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’ ORDER : A request for radiologic service REQUESTED PROCEDURE : A Unit of work resulting in one Report (with associated codified, billable acts)

  9. CLINICIANOR REFERING DOC:The Imaging Dept Customer RADIOLOGIST : In Charge of producing theReport TECHNOLOGIST(and RADIOLOGIST)In charge of acquiring images, etc. Workflow Concept Mapping This 3 level workflow structureis useroriented: 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)

  10. DICOMModality Worklist ScheduledProcedure Step One or more series of images PerformedProcedure Step AcquisitionModality Normal Workflow Typical workflow: One Order – One Procedure – One Report Radiology Department ORDER A request for RadiologicService Set of Codifiable, Billable, Acts Report Requested Procedure

  11. 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 Multiple Modality Steps Radiology Department ORDER A request for RadiologicService Set of Codifiable, Billable, Acts Requested Procedure 1

  12. Scheduled Workflow“HL7 Actors & Transactions” HL7 Actors: • ADT/Patient Registration • Order Placer • DSS / Order Filler • Image Manager

  13. Scheduled WorkflowStandards 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. Scheduled WorkflowStandards 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. Scheduled Workflow“DICOM Actors & Transactions” DICOM Actors: • DSS / Order Filler • PPS Manager • Image Manager /Archive • Acquisition Modality • Evidence Creator • Image Display

  16. Acquisition Workflow Management DICOM: • Modality Worklist Management (MWL) • Modality Performed Procedure Step (MPPS)

  17. Image Management DICOM: • Image Storage • Storage Commitment • Query/Retrieve

  18. Patient Information Reconciliation Expect the Unexpected

  19. Patient Information ReconciliationAbstract / Scope • Extension of Scheduled Workflow • Coordinated update of demographic information in workflow and content objects

  20. Patient Information ReconciliationValue 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

  21. 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.

  22. 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).

  23. Patient Information ReconciliationTransaction Diagram

  24. Department System Image Order ADT Database/Scheduler/ Manager Placer Modality Order Filler Register J.Doe Patient Registration [1] Filler Order Mgmt New Order [3] Schedule Procedure Procedure Scheduled [4] Images Acquired Modality Procedure Modality Procedure Step Completed [7] Step Completed [7] Patient Reconciliation J.Doe -> J.Smith Patient Patient Update [12] Update [12] “Emergency” - Case 3

  25. More information…. • IHE Web site: 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

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