Sept 13-15, 2004 IHE Interoperability Workshop1

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

Scheduled Workflow:The First Profile

Don Van Syckle, DVS Consulting, Inc.

Modified version of profiles delivered in workshop identified below – delivered by Kevin O’Donnell

Sept 13-15, 2004 IHE Interoperability Workshop2

Profile SummaryProfile Summary

Fundamental Starting Point of IHE

Addresses Registration, Scheduling, Acquisition Workflow and Image Content

Bridges HL7 and DICOM Spaces

Sept 13-15, 2004 IHE Interoperability Workshop3

MotivationMotivationPreserve 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

Sept 13-15, 2004 IHE Interoperability Workshop4

MotivationMotivationImprove 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

Sept 13-15, 2004 IHE Interoperability Workshop5

MotivationMotivationImprove 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

Sept 13-15, 2004 IHE Interoperability Workshop6

imagesstored

patientinformation

RIS

examination orders

imagesretrieved

HIS

PACS

procedurescheduled

Prefetch any relevantprior studies

modalityworklist

report

report

Scheduled Workflow ProfileScheduled Workflow Profile

Registration

Orders Placed

Orders Filled

Film

FilmFolder

Image Manager& Archive

FilmLightbox

report ReportRepository

DiagnosticWorkstation

Modality

acquisitionacquisitionin-progressin-progressacquisitioncompleted

acquisitioncompleted

imagesprinted

AcquisitionModality

Sept 13-15, 2004 IHE Interoperability Workshop

IHE Workflow ConceptsIHE Workflow Concepts

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’

IHE has selected three UNAMBIGUOUS IHE has selected three UNAMBIGUOUS HL7/DICOM TERMS : TERMS :

ORDERORDER : : A request for radiologic serviceA request for radiologic service

REQUESTED PROCEDUREREQUESTED PROCEDURE : A Unit of work resulting in : A Unit of work resulting in one Reportone Report (with associated codified, billable acts) (with associated codified, billable acts)

Sept 13-15, 2004 IHE Interoperability Workshop

Workflow Concept MappingWorkflow Concept Mapping

This 3 level workflow structure is user oriented:

OORDER:RDER:A request for A request for imagingimaging service service

(Accession Number)(Accession Number)

REQUESTED PROCEDUREREQUESTED PROCEDURE : : Units of work resulting in one Units of work resulting in one ReportReport

with with associated codified, billable actsassociated codified, billable acts(Requested Procedure ID)(Requested Procedure ID)

PROCEDURE STEPPROCEDURE STEP : :The smallest unit of workThe smallest unit of work

in the workflowin the workflow(modality worklist entry)(modality worklist entry)

CLINICIANCLINICIANOR REFERING DOC:OR REFERING DOC:

The Imaging Dept CustomerThe Imaging Dept Customer

RADIOLOGISTRADIOLOGIST : : In Charge of producingIn Charge of producing

thethe ReportReport

TECHNOLOGISTTECHNOLOGIST(and RADIOLOGIST)(and RADIOLOGIST)

In charge of acquiring In charge of acquiring images, etc.images, etc.

Sept 13-15, 2004 IHE Interoperability Workshop

AcquisitionModality

Normal WorkflowNormal Workflow

ORDERA request for RadiologicService

Radiology Department

Set of Codifiable,

Billable, ActsOne or more series of images

PerformedProcedure

StepRequestedProcedure

ScheduledProcedure

Step

Report

DICOMModality Worklist

Typical workflow: One Order – One Procedure – One Report

Sept 13-15, 2004 IHE Interoperability Workshop

AcquisitionModality

AcquisitionModality

Multiple Modality StepsMultiple Modality Steps

ORDERA request for RadiologicService

Radiology Department

Set of Codifiable,

Billable, ActsOne or more series of images

PerformedProcedure

Step P1

ScheduledProcedure

Step B

RequestedProcedure

1

ScheduledProcedure

Step A

Report

One or more series of images

PerformedProcedure

Step P2

DICOMModality Worklist

DICOMModality Worklist

Sept 13-15, 2004 IHE Interoperability Workshop11

Modality Worklist Provided [5]

ADT Order Placer

Image Manager

Acquisition Modality

Placer Order Mgmt – New [2]

Department System Scheduler/ Order Filler

Procedure Scheduled [4]

Register/Admit Patient

Create Order

Schedule Procedure and/or Assign Protocol

Patient

Registration [1]

Administrative Administrative Normal Process FlowNormal Process Flow

Sept 13-15, 2004 IHE Interoperability Workshop12

Image Manager

Acquisition Modality

Department System Database/Scheduler

/ Order Filler

Image Archive

Modality Procedure Step Completed [7]

Perform Acquisition

Modality Images Stored [8]

Modality Presentation State Stored [9]

Modality Storage Commitment [10]

Modality Procedure Step In Progress [6]

Images Availability Query [11]

Modality Procedure Step Completed [7]

Modality Procedure Step In Progress [6]

Print Composer

Print Request [23]

Print Server

Procedure PerformanceProcedure PerformanceNormal Process FlowNormal Process Flow

Sept 13-15, 2004 IHE Interoperability Workshop13

““HL7 Actors” in SWFHL7 Actors” in SWF

HL7 Actors:ADT/Patient Registration

Order Placer

DSS / Order Filler

Image Manager

1: Pt registration 12: Pt Update

Pt registration: 1 Pt Update: 12

2: Placer Order Management 3: Filler Order Management

ADT

4: Procedure Scheduled 12: Patient Update 13: Procedure Update

Image Manager

Order Placer Order Filler

Sept 13-15, 2004 IHE Interoperability Workshop21

““DICOM Actors” in SWFDICOM Actors” in SWF

DICOM Actors:DSS / Order Filler

PPS Manager

Image Manager /Archive

Acquisition Modality

Evidence Creator

Image Display

Query Images [14] Retrieve Images [16]

Image Display

Storage Commitment [10]

Modality Image Stored [8] Storage Commitment [10]

Creator Images Stored [18]

Procedure Scheduled [4] Image Availability Query [11] Procedure Updated [13] Performed Work Status Update [42] Performed Work Status Update [42]

Modality Worklist Provided [5]

Evidence Creator

Performed Procedure

Step Manager

Modality PS in Progress [6] Modality PS Completed [7] Creator PS in Progress [20] Creator PS Completed [21]

Modality PS in Progress [6] Modality PS Completed [7] Creator PS in Progress [20] Creator PS Completed [21]

Modality PS in Progress [6] Modality PS Completed [7]

Creator PS in Progress [20] Creator PS Completed [21]

Acquisition Modality

Image Manager

Image Archive

DSS/ Order Filler

Sept 13-15, 2004 IHE Interoperability Workshop22

Acquisition Workflow ManagementAcquisition Workflow Management

DICOM:Modality Worklist Management (MWL)

Modality Performed Procedure Step (MPPS)

Query Images [14] Retrieve Images [16]

Image Display

Storage Commitment [10]

Modality Image Stored [8] Storage Commitment [10]

Creator Images Stored [18]

Procedure Scheduled [4] Image Availability Query [11] Procedure Updated [13] Performed Work Status Update [42] Performed Work Status Update [42]

Modality Worklist Provided [5]

Evidence Creator

Performed Procedure

Step Manager

Modality PS in Progress [6] Modality PS Completed [7] Creator PS in Progress [20] Creator PS Completed [21]

Modality PS in Progress [6] Modality PS Completed [7] Creator PS in Progress [20] Creator PS Completed [21]

Modality PS in Progress [6] Modality PS Completed [7]

Creator PS in Progress [20] Creator PS Completed [21]

Acquisition Modality

Image Manager

Image Archive

DSS/ Order Filler

Sept 13-15, 2004 IHE Interoperability Workshop23

Image ManagementImage Management

DICOM:Image Storage

Storage Commitment

Query/Retrieve

Query Images [14] Retrieve Images [16]

Image Display

Storage Commitment [10]

Modality Image Stored [8] Storage Commitment [10]

Creator Images Stored [18]

Procedure Scheduled [4] Image Availability Query [11] Procedure Updated [13] Performed Work Status Update [42] Performed Work Status Update [42]

Modality Worklist Provided [5]

Evidence Creator

Performed Procedure

Step Manager

Modality PS in Progress [6] Modality PS Completed [7] Creator PS in Progress [20] Creator PS Completed [21]

Modality PS in Progress [6] Modality PS Completed [7] Creator PS in Progress [20] Creator PS Completed [21]

Modality PS in Progress [6] Modality PS Completed [7]

Creator PS in Progress [20] Creator PS Completed [21]

Acquisition Modality

Image Manager

Image Archive

DSS/ Order Filler