Integrating the Healthcare Enterprise Understanding and Optimizing Workflow with IHE Charles...

Integrating the Healthcare EnterpriseIntegrating the Healthcare Enterprise

Understanding and OptimizingUnderstanding and OptimizingWorkflow with IHEWorkflow with IHE

Charles Parisot, GE Medical Systems – ITCharles Parisot, GE Medical Systems – IT KevinKevin O'Donnell O'Donnell, , Toshiba AmericaToshiba America Medical Systems Medical Systems

RSNA 20022

IHE Integration Profiles = Integration CapabilitiesIHE Integration Profiles = Integration Capabilities

Access to Radiology InformationRetrieve & view images and reports

Consistent Presentation of Images

Hardcopy and softcopy grayscale presentation state

Key ImageNotes

Flag & search for significant images

Simple Image and Numeric Reports

Simple reports with image links and measurements

Basic SecurityAudit Trail Consolidation & Node Authentication

Presentation of Grouped Procedures

Manage subsets of a single acquisition

Post- Processing Workflow

Schedule, perform, & notify image processing

& CAD steps

Charge Posting

Collection of billable procedure details

Scheduled Workflow

Admit, order, schedule, acquire & store images with notification of

completed steps

Patient Information Reconciliation

Unknown patients and unscheduled orders

RSNA 20023

What are What are Key IHE ConceptsKey IHE Concepts??• Problem/Solution ScenariosProblem/Solution Scenarios -> -> IntegrationIntegration

ProfilesProfiles

• Generalized Systems Generalized Systems -> -> ActorsActors

• Interactions between Actors Interactions between Actors -> -> TransactionsTransactions

• For each Integration Profile:For each Integration Profile:

• the context is described (which real-world problem)the context is described (which real-world problem)

• the actors are defined (what systems are involved)the actors are defined (what systems are involved)

• the transactions are defined (what to communicate)the transactions are defined (what to communicate)

RSNA 20024

imagesstored

patientinformation

RIS

examination orders

imagesretrieved

HIS

PACS

procedurescheduled

Prefetch any relevantprior studies

modalityworklist

report

report

Example: Example: 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

RSNA 20025

The two sides of IHEThe two sides of IHE

• It specifies information flows (requests, images, It specifies information flows (requests, images, tasks done, reports, etc.) between HIS, RIS, tasks done, reports, etc.) between HIS, RIS, PACS, Modalities, Workstations and Printers.PACS, Modalities, Workstations and Printers.

Makes Makes ConnectionsConnections Easier Easier

• It defines a foundation upon which to It defines a foundation upon which to streamline the activities in a radiology streamline the activities in a radiology departmentsdepartments

Makes Makes WorkflowWorkflow Easier EasierThis second point will be our primary focusThis second point will be our primary focus

RSNA 20026

Workflow CapabilitiesWorkflow Capabilities




Key ImageNotes









& CAD steps

Charge Posting


Scheduled Workflow


completed steps



RSNA 20027

Store ImagesStore Images

Storage CommitmentStorage CommitmentStorageStorage

CommitmentCommitment

List of ImagesList of Images

PACS &PACS &ArchiveArchive

RISRIS

ModalityModalityPerformedPerformedProcedure Procedure StepStep

Performed Step:Performed Step:

Status = CompletedStatus = CompletedPerformed CT HeadPerformed CT HeadPat Name/ID, Dose, Pat Name/ID, Dose,

Accession #, Study UIDAccession #, Study UIDComplete List of ImagesComplete List of Images

IHE Scheduled WorkflowIHE Scheduled WorkflowThe Connection sideThe Connection side

Modality WorklistModality Worklist

WorklistWorklist

Procedure ScheduledProcedure Scheduled

Patient Registration/UpdatePatient Registration/UpdateOrder ManagementOrder Management

RSNA 2002

IHE Scheduled WorkflowIHE Scheduled WorkflowThe Workflow sideThe Workflow side

Procedure StepsProcedure Steps : : The smallest unit of work in the workflow:The smallest unit of work in the workflow:

SCHEDULED PROCEDURE STEP: : ‘A unit of work ‘A unit of work to do’to do’

PERFORMED PROCEDURE STEP: : ‘A unit of work ‘A unit of work donedone’’

IHE identifies four fundamental workflow information units :IHE identifies four fundamental workflow information units :

REQUESTED PROCEDURE : : Units of work resulting in Units of work resulting in one Reportone Reportwithwith associated codified, billable acts. associated codified, billable acts.

ORDER : A request for radiologic A request for radiologic

serviceservice

RSNA 2002

IHE Workflow is User DrivenIHE Workflow is User Driven

Information UnitInformation Unit has its has its Prime UserPrime User

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

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

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

in the workflowin the workflow

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.

RSNA 2002

Why distinguishing these 3 concepts ?Why distinguishing these 3 concepts ?

CLINICIANCLINICIANOR REFERING DOC:OR REFERING DOC:I requested an I requested an examexam

RADIOLOGISTRADIOLOGIST : : I reported the I reported the examexam

TECHNOLOGISTTECHNOLOGISTI performed an I performed an examexam

Because not every order results in a single report and Because not every order results in a single report and requires a single acquisition !requires a single acquisition !

OK for chest X-Ray, confusion for a multi-modality OK for chest X-Ray, confusion for a multi-modality acquisitions !acquisitions !

Before IHE ….Before IHE ….

CLINICIANCLINICIANOR REFERING DOC:OR REFERING DOC:

I placed an I placed an OrderOrder

RADIOLOGISTRADIOLOGIST : : I reported theI reported the

requested Procedurerequested Procedure

TECHNOLOGISTTECHNOLOGISTI performed a I performed a

procedure stepprocedure step

With IHE ….With IHE ….

RSNA 2002

OORDER: RDER: A multi-modality case, e.g. chest x-ray + NM ventilationA multi-modality case, e.g. chest x-ray + NM ventilation

REQUESTED PROCEDUREREQUESTED PROCEDURE : one : one ReportReport expectedexpected

An An IHE vocabulary IHE vocabulary forfor Workflow WorkflowOORDER: RDER: A A Simple one, e.g. chest x-raySimple one, e.g. chest x-ray

REQUESTED PROCEDUREREQUESTED PROCEDURE : one : one ReportReport expectedexpected

PROCEDURE STEPPROCEDURE STEP : : Acquisition of chest x-ray Acquisition of chest x-ray

For comprehensive workflowFor comprehensive workflowboth simple and complex cases are supportedboth simple and complex cases are supported

PROCEDURE STEPPROCEDURE STEP : : Acquisition of chest x-ray Acquisition of chest x-ray

PROCEDURE STEPPROCEDURE STEP : : Acquisition of NM Ventilation Acquisition of NM Ventilation

RSNA 200212

IHE Scheduled WorkflowIHE Scheduled Workflow

5 generic workflow cases are specified5 generic workflow cases are specified

RSNA 2002

Simple WorkflowSimple Workflow

ORDERA request for RadiologicService Requested

Procedure

Radiology Department

ReportSet of

Codifiable,Billable,

Acts

Acquisition Modality

One or more series of images

PerformedProcedure

Step

One OrderOne Order – – One Requested Procedure - One Scheduled Procedure One Requested Procedure - One Scheduled Procedure StepStep – One Performed Procedure Step– One Performed Procedure Step–– One ReportOne Report

ScheduledProcedure

Step A

DICOMModality Worklist

RSNA 2002

AcquisitionModality

AcquisitionModality

Multiple Modality StepsMultiple Modality Steps

ORDERA request for RadiologicService



PerformedProcedure

Step P1

ScheduledProcedure

Step B

RequestedProcedure

1

ScheduledProcedure

Step A


RSNA 2002

AcquisitionModality





PerformedProcedure

Step P1

ScheduledProcedure

Step B

RequestedProcedure

1

ScheduledProcedure

Step A


AcquisitionModality


PerformedProcedure

Step P2

RSNA 2002

AcquisitionModality

AcquisitionModality




Set of Codifiable,

Billable, ActsOne or more series of images

PerformedProcedure

Step P1

ScheduledProcedure

Step B

RequestedProcedure

1

ScheduledProcedure

Step A

Report


PerformedProcedure

Step P2

The Requested Procedure collects The Requested Procedure collects Reporting inputs Reporting inputs

RSNA 2002

AcquisitionModality

Append Modality StepsAppend Modality Steps



Set of Codifiable,

Billable, ActsOne or more series of images

PerformedProcedure

Step P1RequestedProcedure

1

ScheduledProcedure

Step A

Report


PerformedProcedure

Step P2

A Requested Procedure A Requested Procedure collectscollects Report inputs Report inputsDICOMModality Worklist


RSNA 2002

AcquisitionModality

Discontinued Procedure StepDiscontinued Procedure Step




PerformedProcedure

Step P1

ReportSet of

Codifiable,Billable, Acts

RequestedProcedure

2ScheduledProcedure

Step C

RequestedProcedure

1ScheduledProcedure

Step A


NoNoPerformedPerformedProcedureProcedure

StepStep

Discontinue


RSNA 2002

Group CaseGroup Case



ReportSet of


AcquisitionModality

ReportSet of


RequestedProcedure

2ScheduledProcedure

Step B

RequestedProcedure

1ScheduledProcedure

Step A


PerformedProcedure

Step P1


Each Requested Procedure Each Requested Procedure collectscollects Report inputs Report inputs

RSNA 200220

Other Other Group cases…Group cases…• CT:CT: Head bone / brain separationHead bone / brain separation• CR:CR: Foot/ankle - hand/wristFoot/ankle - hand/wrist

– E.g., lateral image of foot shared between AP of ankle and AP of footE.g., lateral image of foot shared between AP of ankle and AP of foot

• DR:DR: Trauma patient AP / Lat re-groupingTrauma patient AP / Lat re-grouping– I.e., do all the Aps then rotate the patient once then do LatsI.e., do all the Aps then rotate the patient once then do Lats

• MR:MR: MRI/MRA MRI/MRA – To be To be viewedviewed and and billed separatelybilled separately

• IR:IR: Diagnostic run and therapeutic runDiagnostic run and therapeutic run– Performed contemporaneously, viewed/billed separatelyPerformed contemporaneously, viewed/billed separately

• US:US: Abdomen and kidneys/ retroperitoneumAbdomen and kidneys/ retroperitoneum

The solution is……The solution is……

RSNA 200221

IHE IHE Presentation of Grouped ProceduresPresentation of Grouped ProceduresIntegration ProfilesIntegration Profiles




Key ImageNotes









& CAD steps

Charge Posting


Scheduled Workflow


completed steps



RSNA 200222

IHE Presentation Of Grouped IHE Presentation Of Grouped Procedures WorkflowProcedures Workflow

Allows splitting images resulting from Allows splitting images resulting from a group case on the modalitya group case on the modality

Allows managing the split image sets Allows managing the split image sets on the PACSon the PACS

RSNA 200223

MODALITY

Presentation of Grouped Procedures ProfilePresentation of Grouped Procedures ProfileRequested Procedure:

CHEST

Report:CHEST

Report:AB/PELVIS

Performs a single exam

Operatorgroups

2 procedures

Chest Chest ViewView

RIS / PACS

Requested Procedure:AB/PELVIS

Chest Chest ViewView

Ab/Pelvis Ab/Pelvis ViewView

Ab/Pelvis Ab/Pelvis ViewView

RSNA 200224

Presentation of Grouped ProceduresPresentation of Grouped Procedures

• PGP maintains the link back to each one of the PGP maintains the link back to each one of the grouped procedures:grouped procedures:

– without breaking the acquisition apartwithout breaking the acquisition apart

– Without duplicating imagesWithout duplicating images

• PGP ensures that each image subset related to a PGP ensures that each image subset related to a requested procedure is identified and ready to be requested procedure is identified and ready to be presented.presented.

This is key for quick display of new and prior studies.This is key for quick display of new and prior studies.

RSNA 200225

Two new Workflow Options In Scheduled WorkflowTwo new Workflow Options In Scheduled Workflow




Key ImageNotes









& CAD steps

Charge Posting


Scheduled Workflow


completed steps



RSNA 200226

IHE Scheduled WorkflowIHE Scheduled Workflowwith Assisted Protocol Settingwith Assisted Protocol Setting

PACSPACS

RISRISModality WorklistModality WorklistIncl. Scheduled Incl. Scheduled

Acquisition ProtocolsAcquisition Protocols

New OrderNew Order

OrderOrder

ProtocolizedProtocolizedProposed ProtocolsProposed Protocols

Loaded & ReviewedLoaded & Reviewed

ModalityModalityPerformedPerformedProcedure StepProcedure Step

Includes PerformedIncludes PerformedAcquisition ProtocolsAcquisition Protocols

Store Images

Storage Commitment

Use PerformedUse PerformedAcquisition ProtocolsAcquisition Protocols

Info for charge postingInfo for charge posting

RSNA 200227

IHE Scheduled WorkflowIHE Scheduled Workflowwith with Exception ManagementException Management

PACSPACS

RISRISModality WorklistModality Worklist

New OrderNew Order

ModalityModalityPerformedPerformedProcedure StepProcedure Step

Step DiscontinuedStep DiscontinuedWith ReasonWith Reason

Store Images

Storage Commitment

ExceptionExceptionHappensHappens

If Wrong WorklistIf Wrong Worklist

Images "removed"Images "removed"

and Step "undone"and Step "undone"

e.g. e.g. Wrong WorklistWrong Worklist entry selection entry selection

e.g. Patient Conditione.g. Patient Condition

RSNA 200228

IHE IHE Patient Information ReconciliationPatient Information ReconciliationIntegration ProfileIntegration Profile




Key ImageNotes









& CAD steps

Charge Posting


Scheduled Workflow


completed steps



RSNA 200229

IHE Patient Information ReconciliationIHE Patient Information Reconciliation

ADT PatientRegistration

OrderPlacer

DeptScheduler

ImageManager/Archive

Modality

• When Institution Policy assumes pre-When Institution Policy assumes pre-registration of ER patients (John/Jane registration of ER patients (John/Jane Doe), IHE supports 3 possible cases:Doe), IHE supports 3 possible cases:

• PACS is synchronized with all patient PACS is synchronized with all patient registration and order information registration and order information updates through Dept Scheduler.updates through Dept Scheduler.

3.3. Unidentified Patient registered at Unidentified Patient registered at ADT but ADT but acquisition acquisition completed at completed at ModalityModality prior to Orderprior to Order

1.1. Unidentified Patient registered at Unidentified Patient registered at ADT and order placed at Order ADT and order placed at Order PlacerPlacer

2.2. Unidentified Patient registered at Unidentified Patient registered at ADT and order placed at ADT and order placed at Department Scheduler/Order FillerDepartment Scheduler/Order Filler

RSNA 200230

IHE IHE Scheduled Workflow + Scheduled Workflow + IHE Patient Information ReconciliationIHE Patient Information Reconciliation

ADT PatientRegistration

OrderPlacer

DeptScheduler

ImageManager/Archive

Modality

• When Institution Policy allows When Institution Policy allows departments to register ER patients, departments to register ER patients, IHE supports 2 possible cases:IHE supports 2 possible cases:

1.1. Unidentified Patient assigned Unidentified Patient assigned Temporary Departmental ID andTemporary Departmental ID and Scheduled at DScheduled at Dept ept SSchedulercheduler/Order Filler/Order Filler

2.2. Image Acquisition Completed Image Acquisition Completed WWiithout Scheduling at Dthout Scheduling at Dept ept Scheduler/Scheduler/OrderOrder FillerFiller (Patient ID (Patient ID entered at Modality)entered at Modality)

• Supports cases when ADT or Dept Supports cases when ADT or Dept Scheduler is downScheduler is down

RSNA 200231

What about Reporting Workflow ?What about Reporting Workflow ?1.1. Scheduled Workflow:Scheduled Workflow: Reporting is not explicitly addressed by Scheduled Reporting is not explicitly addressed by Scheduled

Workflow, but can be handled within the Image Manager and Order Filler.Workflow, but can be handled within the Image Manager and Order Filler.

Supported by the Scheduled Workflow Integration ProfileSupported by the Scheduled Workflow Integration Profile

2.2. Simple Image and Numeric Report:Simple Image and Numeric Report: This profile allow to produce a This profile allow to produce a radiology report with coding of key elements and image references. The radiology report with coding of key elements and image references. The workflow is limited to report creation and access. workflow is limited to report creation and access.

Supported by the Scheduled Workflow plus the Simple Image and Supported by the Scheduled Workflow plus the Simple Image and Numeric Integration ProfilesNumeric Integration Profiles

3.3. Diagnostic Workstation:Diagnostic Workstation: The Image Display Actor is only intended to The Image Display Actor is only intended to provide access to images. The Report Creator is only intended to create provide access to images. The Report Creator is only intended to create report documents. A full a diagnostics/ reporting workstation needs to be report documents. A full a diagnostics/ reporting workstation needs to be part of an image manager or order filler.part of an image manager or order filler.

A Full Workflow Integrated Diagnostics/Reporting can easily be A Full Workflow Integrated Diagnostics/Reporting can easily be supported within the image manager (PACS) or Order Filler (RIS) supported within the image manager (PACS) or Order Filler (RIS) with Scheduled Workflow.with Scheduled Workflow.

For a stand-alone diagnostics workstation, an additional profile is For a stand-alone diagnostics workstation, an additional profile is under consideration.under consideration.

RSNA 200232

IHE Integration Profiles = Integration CapabilitiesIHE Integration Profiles = Integration Capabilities




Key ImageNotes









& CAD steps

Charge Posting


Scheduled Workflow


completed steps



RSNA 200233

Where is More Information Where is More Information Available?Available?

www.rsna.org/IHEwww.rsna.org/IHEIHE Technical framework for year 4 – V5.4IHE Technical framework for year 4 – V5.4

Non-Technical Non-Technical BrochureBrochuress : :IHE Primer and IHE FAQIHE Primer and IHE FAQIHE Integration Profiles: Guidelines for BuyersIHE Integration Profiles: Guidelines for BuyersIHE Connectathon ResultsIHE Connectathon Results

Ask Vendors for products IHE Integration Statements !Ask Vendors for products IHE Integration Statements !

Integrating the Healthcare Enterprise Understanding and Optimizing Workflow with IHE Charles...

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