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Cardiac Cath Workflow

June 28-29, 2005. IHE Workshop. 2. The Problem. Cardiac Cath is a complex procedure with a challenging workflowMany times the procedure is not scheduledMany times the patient demographics are unknownEvidence-gathering can start prior to an orderMultiple devices collect data for the procedureMos

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Cardiac Cath Workflow

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    2. June 28-29, 2005 IHE Workshop 2 The Problem Cardiac Cath is a complex procedure with a challenging workflow Many times the procedure is not scheduled Many times the patient demographics are unknown Evidence-gathering can start prior to an order Multiple devices collect data for the procedure Most procedures begin as diagnostic and extend to an interventional

    3. June 28-29, 2005 IHE Workshop 3 The Problem Can you see it?

    4. June 28-29, 2005 IHE Workshop 4 Cardiac Cath Workflow Abstract This profile establishes the continuity and integrity of basic patient data by managing the workflow, in particular: Management of cath exams Multi-modality, multiple procedure steps Reconciliation of patient information Unscheduled and emergency procedures Time synchronization X-ray, hemo, IVUS

    5. June 28-29, 2005 IHE Workshop 5 Cardiac Cath Workflow Value Proposition This profile provides the very basis for data consistency across the disparate modalities within the cath lab.

    6. June 28-29, 2005 IHE Workshop 6 Cardiac Cath Workflow Transaction Diagram

    7. June 28-29, 2005 IHE Workshop 7 Cardiac Cath Workflow Actors Acquisition Modality – A system that acquires and creates medical images or waveforms while a patient is present, e.g., an X-ray angiography or hemodynamic measurement system. A modality may also create other evidence objects such as Structured Report Documents containing measurements. ADT – A system responsible for adding and/or updating patient demographic and encounter information (Admission/Discharge/Transfer). In particular, it registers a new patient with the Order Placer and Department System. Department System Scheduler/Order Filler – A department-based (for instance, Cardiology or Radiology) information system that provides functions related to the management of orders received from external systems or through the department system’s user interface. Evidence Creator – A system that creates additional evidence objects, such as derived images or measurements. Image Archive – A system that provides long term storage of evidence objects such as images, presentation states, Key Image Notes and Evidence Documents.

    8. June 28-29, 2005 IHE Workshop 8 Cardiac Cath Workflow Actors Image Display – A system that offers browsing of patients’ studies. In addition, it may support the retrieval and display of selected evidence objects including sets of images, presentation states, Key Image Notes, and/or Evidence Documents. Image Manager – A system that provides functions related to safe storage and management of evidence objects. It supplies availability information for those objects to the Department System Scheduler. Order Placer – A hospital or enterprise-wide system that generates orders for various departments and distributes those orders to the correct department. Performed Procedure Step Manager – A system that re-distributes the Modality Performed Procedure Step information from the Acquisition Modality to the Department System Scheduler/Order Filler and Image Manager. Time Client – A system unit that synchronizes its time of day clock to the correct time provided by a time server

    9. June 28-29, 2005 IHE Workshop 9 Cardiac Cath Workflow Transactions Patient Registration – The ADT system registers and/or admits a patient and forwards the information to other information systems. [RAD-1] Placer Order Management – The Order Placer informs the Order Filler of the initiation or cancellation of an order. The Placer/Filler Order Management transaction will sometimes be referred to as “-New” when a new order is being initiated, or as “-Cancel” when an existing order is canceled. [RAD-2] Filler Order Management – The Order Filler informs the Order Placer of the initiation, cancellation, or change in the status of an order. The Placer/Filler Order Management transaction will sometimes be referred to as “-New” when a new order is being initiated, or as “-Cancel” when an existing order is canceled. [RAD-3] Procedure Scheduled – Schedule information is sent from the Department System Scheduler/Order Filler to the Image Manager. [RAD-4] Query Modality Worklist – Based on a query entered at the Acquisition Modality, a modality worklist is generated listing all the items that satisfy the query. This list of Scheduled Procedure Steps with selected demographic information is returned to the Acquisition Modality [RAD-5].

    10. June 28-29, 2005 IHE Workshop 10 Cardiac Cath Workflow Transactions Modality Procedure Step In Progress – An Acquisition Modality notifies the Performed Procedure Step Manager of the start of a new Procedure Step and the PPS Manager informs the Department System Scheduler/Order Filler and Image Manager. [CARD-1, derived from RAD-6 Modality Procedure Step Completed – An Acquisition Modality notifies the Performed Procedure Step Manager of the completion of a Procedure Step and the PPS Manager informs the Department System Scheduler/Order Filler and Image Manager. [RAD-7] Modality Images/Evidence Stored – An Acquisition Modality sends acquired or generated images, waveforms, or other evidence documents to the Image Archive. [CARD-2, derived from RAD-8 and RAD-43] Storage Commitment – A requestor (Acquisition Modality) requests that the Image Manager confirm ownership for the specified DICOM objects (images, waveforms, evidence documents, or any combination thereof) that the requestor stored in the Image Archive, thus allowing the sender to delete those objects now owned by the Image Manager. [CARD-3, derived from RAD-10]

    11. June 28-29, 2005 IHE Workshop 11 Cardiac Cath Workflow Transactions Patient Update – The ADT Patient Registration System informs the Order Placer and the Department System Scheduler/Order Filler of new information for a particular patient. The Department System Scheduler may then further inform the Image Manager. [RAD-12] Procedure Update – The Department System Scheduler/Order Filler sends the Image Manager updated order or procedure information. [RAD-13] Query Images – An Image Display queries the Image Archive for a list of entries representing images by patient, study, series, or instance. [RAD-14] Retrieve Images – An Image Display requests and retrieves a particular image or set of images from the Image Archive. [CARD-4, derived from RAD-16] Maintain Time – Synchronize the local time with the time maintained by the Time Server. [ITI-1]

    12. June 28-29, 2005 IHE Workshop 12 Cardiac Cath Workflow Options Instance Availability Notification – The Image Manager/Image Archive notifies interested workflow actors (such as the Department System Scheduler/Order Filler and Report Manager) about the availability status of instances at specified storage locations. [RAD-49] PPS Exception Management – The Acquisition Modality Actor will provide an appropriate reason code for the DISCONTINUED status of the MPPS message using one of the values defined in DICOM 2003 PS 3.16 Annex B Context ID 9300. Availability of PPS-Referenced Instances – As a result of receiving the notification, the Department System Scheduler/Order Filler (or other actors) shall take appropriate action knowing that the referenced instances are available for further use in the workflow.

    13. June 28-29, 2005 IHE Workshop 13 Cardiac Cath Workflow Use Cases All use cases must be supported Case C1: Patient Registered at ADT and Procedure Ordered at the Order Placer Case C2: Patient Registered at ADT and Procedure Ordered at DSS/OF Case C3: Patient Registered at ADT and Procedure Not Ordered Case C4: Patient Registered at DSS/OF and Procedure Ordered Case C5: Patient Not Registered Case C6: Patient Updated During Procedure Case C7: Change Rooms During Procedure Case C8: Cancel Procedure Case C9: Post-Procedure Evidence Creation

    14. June 28-29, 2005 IHE Workshop 14 Case C1: Patient Registered at ADT and Procedure Ordered at the Order Placer Clinical Context Corresponds to traditional Radiology workflow Order placed in central system Also deals with case where emergency identifier has been created Common identifiers known ahead of time IHE Context MPPS in Progress from first modality used to update worklists for others

    15. June 28-29, 2005 IHE Workshop 15 Case C2: Patient Registered at ADT and Procedure Ordered at DSS/OF Clinical Context Slight difference to Case 1 Order placed NOT in central system but in department Department system provides info to Central ordering system Typical of many institutes, relieves need for HIS terminal in lab IHE Context Filler Order Management (New Order) transaction [RAD-3] is sent from Department System Scheduler/Order Filler to the Order Placer.

    16. June 28-29, 2005 IHE Workshop 16 Case C3: Patient Registered at ADT and Procedure Not Ordered Clinical Context Slight difference to Case 2 Procedural information is NOT entered at the departmental system The first modality must initiate the process of creating common procedure identifiers (usually hemo) The common procedure identifiers are created by the departmental system based on the information available from the first modality Can generate a “generic cath procedure” if no coded procedural type is available IHE Context Upon receiving the first MPPS the DSS/OF will auto generate a Requested Procedure and its associated Scheduled Procedure Steps utilizing the Study UID provided in the first MPPS. All other modalities use the Query Modality Worklist transaction.

    17. June 28-29, 2005 IHE Workshop 17 Case C4: Patient Registered at DSS/OF and Procedure Ordered

    18. June 28-29, 2005 IHE Workshop 18 Case C5: Patient Not Registered

    19. June 28-29, 2005 IHE Workshop 19 Case C6: Patient Updated During Procedure

    20. June 28-29, 2005 IHE Workshop 20 Case C7: Change Rooms During Procedure

    21. June 28-29, 2005 IHE Workshop 21 Case C8: Cancel Procedure

    22. June 28-29, 2005 IHE Workshop 22 Case C9: Post-Procedure Evidence Creation

    23. June 28-29, 2005 IHE Workshop 23 More information…. IHE Web sites: www.ihe.net Technical Frameworks, Supplements Radiology Technical Framework Cardiology Technical Framework Cath and Echo Options for Evidence Documents Supplement 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

    24. June 28-29, 2005 IHE Workshop 24 Providers and Vendors Working Together to Deliver Interoperable Health Information Systems In the Enterprise and Across Care Settings

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