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Integrating the Healthcare Enterprise

This profile addresses registration, scheduling, acquisition workflow, and image content, bridging HL7 and DICOM spaces. It improves order tracking, workflow efficiency, and demographic integrity.

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Integrating the Healthcare Enterprise

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  1. Integrating the Healthcare Enterprise Scheduled Workflow:The First Profile Kevin O’Donnell (Toshiba Corp.) Co-chair, IHE Radiology Planning Cmte IHE Interoperability Workshop

  2. Profile Summary • 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. “ IHE Interoperability Workshop

  3. Profile Summary • Fundamental Starting Point of IHE • Addresses Registration, Scheduling, Acquisition Workflow and Image Content • Bridges HL7 and DICOM Spaces IHE Interoperability Workshop

  4. Cardiology Workflow • IHE Cardiology introduced workflow profiles this year • Cath Lab Workflow Profile • Echo Workflow Profile • Based on concepts, actors and most of the transactions described here • Much of this presentation applies to the Cardiology profiles IHE Interoperability Workshop

  5. Motivation • 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 IHE Interoperability Workshop

  6. Motivation • 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 IHE Interoperability Workshop

  7. Motivation • 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 IHE Interoperability Workshop

  8. <Refer to concrete benefit discussions earlier in the workshop> • <Fix the template> IHE Interoperability Workshop

  9. Scheduled Workflow Profile 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 IHE Interoperability Workshop

  10. 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)

  11. Workflow Concept Mapping CLINICIANOR REFERING DOC:The Imaging Dept Customer RADIOLOGIST : In Charge of producing theReport TECHNOLOGIST(and RADIOLOGIST)In charge of acquiring images, etc. 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)

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

  13. 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

  14. “HL7 Actors” in SWF HL7 Actors: • ADT/Patient Registration • Order Placer • DSS / Order Filler • Image Manager IHE Interoperability Workshop

  15. “DICOM Actors” in SWF DICOM Actors: • DSS / Order Filler • PPS Manager • Image Manager /Archive • Acquisition Modality • Evidence Creator • Image Display IHE Interoperability Workshop

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

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

  18. Administrative Normal Process Flow IHE Interoperability Workshop

  19. Procedure PerformanceNormal Process Flow IHE Interoperability Workshop

  20. Assisted Protocol Setting Option • Motivation • Reduce variance on how procedures are performed • Centralize configuration effort • Mechanism • Order Filler/DSS passes Protocol Codes to the Acquisition Modality inside the Worklist Item IHE Interoperability Workshop

  21. PPS Exception Management Option • Motivation • Provide better feedback on discontinued studies • Handle selection of wrong worklist item • Mechanism • Code (0008,0104) IHE Interoperability Workshop

  22. Code Meaning (0008,0104) Discontinue Reason Codes Doctor cancelled procedure Equipment failure Incorrect procedure ordered Patient allergic to media/contrast Patient died Patient refused to continue procedure Patient taken for treatment or surgery Patient did not arrive Patient pregnant Change of procedure for correct charging Duplicate order Nursing unit cancel Incorrect side ordered Discontinued for unspecified reason Incorrect worklist entry selected Patient condition IHE Interoperability Workshop

  23. New SWF Options This Year • Departmental Appointment Notification • Instance Availability Notification • Refer to later presentation IHE Interoperability Workshop

  24. SWF Synergies • Additional Content Profiles • Workflow can manage creation of other objects • Post-Processing Workflow • SWF Status can trigger Post-Processing • SWF Output can be input to Post-Processing • Reporting Workflow • SWF Status can trigger Reporting • SWF Output can be input to Reporting • Charge Posting • SWF Status can trigger/feed Billing • Presentation of Grouped Procedures • Specializes SWF for Grouped Procedures IHE Interoperability Workshop

  25. References • Profile - Volume 1, Chapter 3 • Transactions - Volume 2 • Note Vol. 2, Appendix A, B – Attribute Mapping IHE Interoperability Workshop

  26. Patient Information Reconciliation Expect the Unexpected IHE Interoperability Workshop

  27. Profile Summary • Extension of existing profile • Coordinated update of demographic information in workflow and content objects IHE Interoperability Workshop

  28. Motivation • 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 IHE Interoperability Workshop

  29. 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. IHE Interoperability Workshop

  30. 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). IHE Interoperability Workshop

  31. “Emergency” - Case 3 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] IHE Interoperability Workshop

  32. More information…. • IHE Web sites: http://www.himss.org/IHE http://www.rsna.org/IHE http://www.acc.org/quality/ihe.htm. • Technical Frameworks: • ITI V1.0, RAD V5.5, LAB V1.0 • Technical Framework Supplements - Trial Implementation • May 2004: Radiology • August 2004: Cardiology, IT Infrastructure • 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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