SWF Options/Charge Posting Andrei Leontiev Dynamic Imaging IHE Radiology Planning Committee

SWF Options/Charge Posting

Andrei LeontievDynamic Imaging

IHE Radiology Planning Committee

June 28-29, 2005 IHE Interoperability Workshop2

Scheduled Workflow Options

• Multiple options Scheduled Workflow Profile allow certain degree of workflow “tune-up”– Managing Workflow: Patient-based or Broad

Worklist Queries, Assisted Protocol Setting, Exception Management, Billing and Material Management

– Notifications of Performed Work Status or Availability of Results: Images, Other Evidence documents, Appointments


Modality Options in SWFTransaction Diagram

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


Assisted Protocol OptionValue Proposition

• Gives the Department System Scheduler an option to directly control protocol settings on the Modality.

• Reduces variance on how procedures are performed • Centralizes configuration effort


Assisted Protocol OptionDefinition

• Actors Affected– Modality

– Order Filler/DSS

– Image Manager/Archive

– Report Manager

• Transactions Affected– PPS In-Progress

• Standards Used– DICOM (Modality Worklist and MPPS)


Assisted Protocol OptionMechanism

• Mechanism– Order Filler/DSS passes Scheduled Protocol Codes to the

Acquisition Modality inside the Modality Worklist Item (DICOM)

– Modality configuration is set accordingly either automatically or manually accepted/modified by operator

– Modality populates Performed Protocol Code information in MPPS

– The Protocol Code tables in all actors have to be synchronized


PPS Exception Management OptionValue Proposition

• Provides better feedback on discontinued studies• Handles selection of wrong worklist item


PPS Exception Management Option Definition

• Actors Affected– Modality


– Image Manager/Archive

– Report Manager

• Transactions Affected– PPS Completed

• Standards Used– DICOM (MPPS)


Exception Management OptionMechanism

• Mechanism– Provision of Discontinue Reason Code in PPS Completed transaction:

• 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 prevented continuing


Appointment NotificationValue Proposition

• Provides a mechanism for the Order Placer to keep track of appointments scheduled for a patient within Radiology Department

• Includes notifications of scheduling, re-scheduling and cancellation events

• Helps synchronization of scheduling processes between enterprise and radiology


Appointment Notification Option Definition

• Actors Affected– Order Filler/DSS

– Order Placer

• Standards Used– HL7 v. 2.4 SIU messages

• Transactions affected– Appointment Notification


Appointment Notification OptionMechanism

• Mechanism– One appointment corresponds to one or more

Scheduled Procedure Steps– Department System Scheduler/Order Filler

generates Appointment Notification messages and sends them to the corresponding Order Placer actor.

– One message may convey multiple appointments corresponding to a single order

– Order Placer receives Appointment Notification messages and internally processes them.


Appointment Notification OptionDetails

• Specifies common information for one or more appointments associated with single order

• Appointment timing is defined on the per Scheduled Procedure Step level– One message can have multiple appointments (procedure

steps)• No patient identification information is required,

thus Order Numbers are required• Specifies Procedure Code and Description

– Not all steps of the procedure may be included• Date/Time of an appointment is expected to be in

UTC– If local, UTC offset is required


What is not in the option

• Departmental Appointment Notification Option does not allow Order Placer to request re-scheduling – it only can do it by cancel and re-order

• Transaction does not require AIL segment – thus notifications on re-scheduling of the service from one location to another may not be sent

• This option does not address needs of enterprise-wide scheduling


Instance Availability NotificationValue Proposition

• Enhances mechanism that allows to obtain information about availability of newly-acquired images and other evidence objects, for further use in workflow.

• Avoids “performance penalty” of Instance Availability query mechanism that forces “managers” to poll Image Manager/Archive for availability of evidence objects.

• Provides this information to all workflow management actors.


Instance Availability Notification Option Definition

• Actors Affected– Image Manager/Archive


– Post-Processing Manager

– Report Manager

• Standards Used– DICOM (Instance Availability Notification SOP Class;

Supplement 93 Final Text)

• Transactions affected– Instance Availability Notification


Instance Availability Notification OptionMechanism

• Mechanism– Image Manager/Image Archive generates an

Instance Availability Notification message and send it to the DSS/Order Filler and optionally to other workflow managing actors (Post-Processing Manager, Report Manager).

– DSS/Order Filler, Post-Processing Manager, Report Manager receive an Instance Availability Notification message and internally process it..


Instance Availability Values

• “ONLINE” – the instances are immediately available from the Retrieve

AE Title, and if a C-MOVE were to be requested, it would succeed in a reasonably short time

• “NEARLINE” – the instances need to be retrieved from relatively slow media

such as optical disk or tape, and if a C-MOVE were to be requested from the Retrieve AE Title, it would succeed, but may take a considerable time


Instance Availability Values

• “OFFLINE” – manual intervention is needed before the instances may be

retrieved, and if a C-MOVE were to be requested from the Retrieve AE Title, it would fail (e.g., by timeout) without such manual intervention.

• “UNAVAILABLE” – the instances cannot be retrieved from the Retrieve AE Title,

and if a C-MOVE were to be requested, it would fail. Note that SOP Instances that are unavailable from this AE may be available from other AEs, or may have an alternate representation that is available from this AE.


Instance Availability Notification OptionDetails

• Image Manager shall send only one IAN message for each MPPS referencing at least one evidence object.

• Image Manager shall sent IAN when it received ALL instances referenced in MPPS

• Timing of a message can vary significantly depending on timing of MPPS and object storage

• No message may be sent if complete object set never arrives

• No message may be sent if objects arrive without corresponding MPPS

• Even when objects are included in IAN, the retrieval request may fail due to errors


Instance Availability Notification OptionDetails

• Actors receiving IAN message are expected to use its content for workflow management.

• Examples of internal actions:– The Department System Scheduler/Order Filler may

update the procedure status internally, indicating that images for the procedure have been stored.

– The Post-Processing Manager may add or re-arrange items to a corresponding worklist.

– The Report Manager may add items to a corresponding worklist.


What is not in the option

• This option only addresses the use case when MPPS referencing evidence objects has been received by Image Manager.

• Image Manager generates Instance Availability Notification upon receiving of all objects referenced in particular MPPS.

• Cross-referencing of MPPS in IAN may compensate for MPPS missed by OF


Charge PostingAbstract / Scope

• The Department System Scheduler/Order Filler provides the procedure data that is used by the Charge Processor to generate claims and submit them to payors. – Fees associated with the procedures may be defined by the

Department System Scheduler/Order Filler or by the Charge Processor.

– Claim/Bill creation from charges and communication with payors is out of scope of the profile


Charge PostingValue Proposition

• Standardizes data exchange of charges from radiology to the financial systems

• Reduces the need of the billing system to have knowledge of the radiology internals.

• Charge Processor receives more complete, timely and accurate data.


Charge PostingTransaction Diagram

RAD-36: Account Management

ADT

Acquisition Modality

Performed Procedure

Step Manager

RAD-6: Modality PS In Progress RAD-7: Modality PS Completed RAD-20: Creator PS In Progress RAD-21: Creator PS Completed

RAD-6: Modality PS In Progress RAD-7: Modality PS Completed

DSS/Order Filler

Charge Processor RAD-35: Charge Posted

Report Manager

Evidence Creator

RAD-20: Creator PS In Progress RAD-21: Creator PS Completed

RAD-42: Performed Work Status Update

Post-Processing Manager

RAD-39: Workitem Completed


Charge PostingStandards Used

• Health Level Seven, Version 2.3.1: Chapter 6 - Financial Management– DFT^P03 message

• DICOM 2003 PS 3.4 Modality Performed Procedure Step SOP Class– Billing and Materials Management module – allows

Modality specify billing information, including material consumption (contrast, film, etc.)


More information….• IHE Web site: http://www.ihe.net

http://www.himss.org/IHEhttp://www.rsna.org/IHEhttp://www.acc.org/quality/ihe.htm

• Technical Frameworks• Technical Framework Supplements – Trial Implementation

• 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

Questio

ns?

Questio

ns?

Documents

SWF Options/Charge Posting Andrei Leontiev Dynamic Imaging IHE Radiology Planning Committee