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Continuity of Care virtual tour

Continuity of Care virtual tour. HL7-IHE Demonstration HIMSS 2004. John Madden, MD, PhD, Duke University Medical Center, Department of Pathology Liora Alschuler, HL7/the-word-electric. Presented by. John is a 70-year old man with a 100-pack-year smoking history

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Continuity of Care virtual tour

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  1. Continuity of Carevirtual tour HL7-IHE Demonstration HIMSS 2004

  2. John Madden, MD, PhD, Duke University Medical Center, Department of Pathology Liora Alschuler, HL7/the-word-electric Presented by

  3. John is a 70-year old man with a 100-pack-year smoking history He recently developed persistent cough with blood-streaked sputum He visits Dr. Sullivan, his Primary Care Provider (PCP) Dr. Sullivan sends John to a nearby radiology practice for a chest x-ray Continuity of CarePatient scenario

  4. Continuity of Care Imaging Integration, Tumor Reporting, Claims Processing HL7 Standards aECG Arden CCOW CDA ODM LDM RIM SDM SPL V2 V3 IHE Profiles CT EUA PIX PSA RID SWF Adobe Berdy Carefx CommerceNet DCRI Dictaphone Digital Infuzion Eclipsys Epic GE Heartlab IBM INFINITT Kodak Kryptiq Microsoft Misys Mortara NIST Philips Raining Data Sentillion Siemens SNOMED XIMIS Imaging RIS Workstation Server Repository PCP Registry Server relays copy of imageto repository. Repository forwards document information to registry. PCP sends order to radiology office Radiology information systemqueries scheduling server Imaging modality queries schedulingserver for demographics Imaging system uploads completedimage to server Outpatient encounter and chest xray Scheduled workflow; report stored as CDA

  5. Chest x-ray shows a 3 cm right upper lobe mass Radiologists communicate result to Dr. Sullivan the same day She refers John to Dr. Blade, a chest surgeon at the South Hospital Medical Center Continuity of CarePatient scenario

  6. Continuity of Care Imaging Integration, Tumor Reporting, Claims Processing HL7 Standards aECG Arden CCOW CDA ODM LDM RIM SDM SPL V2 V3 IHE Profiles CT EUA PIX PSA RID SWF Adobe Berdy Carefx CommerceNet DCRI Dictaphone Digital Infuzion Eclipsys Epic GE Heartlab IBM INFINITT Kodak Kryptiq Microsoft Misys Mortara NIST Philips Raining Data Sentillion Siemens SNOMED XIMIS Imaging RIS Workstation Server Broker Repository EMR PCP eForms Registry Clinic queries community radiology server for availability of x-rays Server/WS PCP enters referral requestvia eForms application Broker forwards referral to South Med Center and torepository/registry Hospital EMR distributes referral request and schedules patient visit EMR EMR Hospital Surgery Patient referred for surgery EMR & eForms CCR sent through brokers to hospital, surgery

  7. Medical center radiology obtains outside chest x-ray on behalf of Dr. Blade and reviews it for the South Hospital medical record Dr. Blade meets with John and personally reviews the outside x-ray He determines that John will require surgery Continuity of CarePatient scenario

  8. Continuity of Care Imaging Integration, Tumor Reporting, Claims Processing Medical dictation service delivers radiology review note to repository HL7 Standards aECG Arden CCOW CDA ODM LDM RIM SDM SPL V2 V3 IHE Profiles CT EUA PIX PSA RID SWF Adobe Berdy Carefx CommerceNet DCRI Dictaphone Digital Infuzion Eclipsys Epic GE Heartlab IBM INFINITT Kodak Kryptiq Microsoft Misys Mortara NIST Philips Raining Data Sentillion Siemens SNOMED XIMIS Imaging RIS Workstation Outside image and report delivered to surgeon’s consultation room Dictation Server Identity server EMR PCP eForms Registry Identity server verifies outside patient record number During consultation, Dr. Blade requests a low-resolution version of x-ray to review on office computer with John’s family Med Ctr radiology reviews community images and issues report Hospital Surgery Surgeon reviews imaging reports RID query, CDA link to PACS, reg/rep for consulting report

  9. Dr. Blade admits John He orders a preoperative chest CT Continuity of CarePatient scenario

  10. Continuity of Care Imaging Integration, Tumor Reporting, Claims Processing Adobe Berdy Carefx CommerceNet DCRI Dictaphone Digital Infuzion Eclipsys Epic GE Heartlab IBM INFINITT Kodak Kryptiq Microsoft Misys Mortara NIST Philips Raining Data Sentillion Siemens SNOMED XIMIS HL7 Standards aECG Arden CCOW CDA ODM LDM RIM SDM SPL V2 V3 IHE Profiles CT EUA PIX PSA RID SWF Imaging RIS Workstation Dictation Server Repository Broker EMR PCP eForms Registry CT scheduled… …and reported …performed Imaging John is admitted, preoperative CT ordered Hospital Surgery Patient admitted; Pre-op CT, consult EMR sends admit message; orders imaging; report converted from V2 to CDA

  11. Dr. Blade performs wedge resection of RUL with node sampling Specimen is examined by pathology; the diagnosis is large cell carcinoma with negative nodes Pathology report is sent to Dr. Blade, hospital Tumor Registry A copy is sent to the PCP, Dr. Sullivan Continuity of CarePatient scenario

  12. Continuity of Care Imaging Integration, Tumor Reporting, Claims Processing Dr. Blade composes discharge summary, dictation service queries registry for location of referenced documents Discharge summary posted, copy forwarded to PCP’s broker Adobe Berdy Carefx CommerceNet DCRI Dictaphone Digital Infuzion Eclipsys Epic GE Heartlab IBM INFINITT Kodak Kryptiq Microsoft Misys Mortara NIST Philips Raining Data Sentillion Siemens SNOMED XIMIS HL7 Standards aECG Arden CCOW CDA ODM LDM RIM SDM SPL V2 V3 IHE Profiles CT EUA PIX PSA RID SWF Imaging RIS Workstation Dictation Server Coded format auto-generated for tumor registry from CDA data Repository Broker EMR PCP Broker eForms Registry Tumor Registry Pathology report ordered… Pathology …and reported PCP requests copy of discharge summary in encrypted email from broker Hospital Surgery Pathology Report; Surgical Report; Referral For patient chart and Tumor Registry; CCR back to PCP

  13. South Hospital A singledata REPRESENTATIONstandard facilitates multiple document PRESENTATIONstandards ! Repository view: HL7-CDA standard XML with XQuery-ready, context-linked SNOMED encodings Tumor registrar view: Irrelevant items filtered, stage computed automatically Pathologist view: CAP/ACoS standards compliant, template-driven data entry Clinician view: Traditional format, print/electronic delivery

  14. Dr. Sullivan submits a claim to payer Payer requests more information Continuity of CarePatient scenario

  15. Continuity of Care Imaging Integration, Tumor Reporting, Claims Processing Adobe Berdy Carefx CommerceNet DCRI Dictaphone Digital Infuzion Eclipsys Epic GE Heartlab IBM INFINITT Kodak Kryptiq Microsoft Misys Mortara NIST Philips Raining Data Sentillion Siemens SNOMED XIMIS HL7 Standards aECG Arden CCOW CDA ODM LDM RIM SDM SPL V2 V3 IHE Profiles CT EUA PIX PSA RID SWF Imaging RIS Workstation Dictation Server Payer Repository Broker EMR Broker PCP eForms Registry Tumor Registry Pathology Hospital Surgery Brokered Claim; Registry Discovery For patient chart and Tumor Registry; CCR back to PCP

  16. Continuity of Care Imaging Integration, Tumor Reporting, Claims Processing Adobe Berdy Carefx CommerceNet DCRI Dictaphone Digital Infuzion Eclipsys Epic GE Heartlab IBM INFINITT Kodak Kryptiq Microsoft Misys Mortara NIST Philips Raining Data Sentillion Siemens SNOMED XIMIS HL7 Standards aECG Arden CCOW CDA ODM LDM RIM SDM SPL V2 V3 IHE Profiles CT EUA PIX PSA RID SWF Imaging RIS Workstation Dictation Server Payer Broker EMR Repository PCP eForms ? Registry vEHR Tumor Registry Pathology Hospital Imaging Virtual EHR Ubiquitous Access to Distributed Information

  17. Continuity of CareMini-tours • Tour 1: Referrals & Repository • Tour 2: Pictures & Words • Tour 3: Putting it all together

  18. Continuity of CareMini-tour 1Referrals & Repository • Order origination • CDA export/import • Report creation • Referrals • Discharge summary

  19. Continuity of CareMini-tour 2Pictures & Words • Radiology workflow & standards • Dictation • CCOW

  20. Continuity of CareMini-tour 3Putting it all together • Message routing • Repository & registry • Virtual EHR • Financials

  21. Thank you! • Questions? • Tours starting now

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