Integrating 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 ODonnell

Sept 13-15, 2004 1 IHE Interoperability Workshop

 Profile Summary

Fundamental Starting Point of IHE

Addresses Registration, Scheduling,

Acquisition Workflow and Image Content

Bridges HL7 and DICOM Spaces

Sept 13-15, 2004 2 IHE Interoperability Workshop

 Motivation
Preserve 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 3 IHE Interoperability Workshop

 Motivation
Improve 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 4 IHE Interoperability Workshop

 Motivation
Improve 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 5 IHE Interoperability Workshop

 Scheduled Workflow Profile
report
report
Registration Report
report
Repository

HIS patient Diagnostic Film

information Workstation Lightbox
images
PACS retrieved

Orders Placed
procedure
scheduled Film
Prefetch any relevant Image Manager
Folder
examination orders & Archive
prior studies
modality Acquisition
images
worklist Modality
Orders Filled stored
RIS acquisition
completed
acquisition Film
in-progress
completed images
printed
Modality IHE Interoperability Workshop
Sept 13-15, 2004 6
 IHE Workflow Concepts
IHE has selected three UNAMBIGUOUS HL7/DICOM TERMS :

ORDER : A request for radiologic service

REQUESTED PROCEDURE : A Unit of work resulting in one Report

(with associated codified, billable acts)

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
 Workflow Concept Mapping
This 3 level workflow structure is user oriented:

ORDER: CLINICIAN
A request for imaging service OR REFERING DOC:
(Accession Number) The Imaging Dept Customer

REQUESTED PROCEDURE : RADIOLOGIST :

Units of work resulting in one Report In Charge of producing
with associated codified, billable acts the Report
(Requested Procedure ID)

TECHNOLOGIST
PROCEDURE STEP :
(and RADIOLOGIST)
The smallest unit of work
In charge of acquiring
in the workflow
images, etc.
(modality worklist entry)
 Normal Workflow
Typical workflow: One Order One Procedure One Report

Radiology Department
DICOM
Modality Worklist
ORDER
Scheduled
A request for Performed
Procedure
Radiologic Step Procedure
Service Step Set of
Requested Report
Procedure Codifiable,
One or Billable, Acts
more series
of images

Acquisition
Modality
 Multiple Modality Steps
DICOM
Modality Worklist Radiology Department
ORDER
Scheduled
A request for Performed
Procedure
Radiologic Step A Procedure
Service Step P1 Set of
Requested Report
Procedure Codifiable,
1 One or Billable, Acts
more series
of images
Scheduled
Procedure Performed
Step B Acquisition
Procedure
Step P2 Modality
DICOM
Modality Worklist One or
more series
of images

Acquisition
Modality
 Administrative
Normal Process Flow
ADT Order Department System Image Acquisition
Placer Scheduler/ Order Filler Manager Modality

Register/
Admit
Patient
Patient
Registration [1]

Create Order

Placer Order Schedule Procedure and/or

Mgmt New [2] Assign Protocol

Procedure
Scheduled [4]
Modality Worklist
Provided [5]

Sept 13-15, 2004 11 IHE Interoperability Workshop

 Procedure Performance
Normal Process Flow
Department System Image Acquisition Image Print
Database/Scheduler Manager Modality Archive Server
/ Order Filler
Print
Composer
Modality Procedure Modality Procedure
Step In Progress [6] Step In Progress [6]

Perform
Acquisition
Modality Images
Stored [8]

Modality
Presentation State
Modality Procedure Stored [9]
Modality Procedure
Step Completed [7] Step Completed [7]

Modality Storage Print Request [23]

Commitment [10]

Images Availability
Query [11]

Sept 13-15, 2004 12 IHE Interoperability Workshop

 HL7 Actors in SWF

ADT

Pt registration: 1 1: Pt registration
Pt Update: 12
2: Placer Order Management
12: Pt Update HL7 Actors:
3: Filler Order Management
Order Filler Order Placer
ADT/Patient
4: Procedure Scheduled
Registration
12: Patient Update
13: Procedure Update
Order Placer
DSS / Order Filler
Image Image Manager
Manager

Sept 13-15, 2004 13 IHE Interoperability Workshop

 DICOM Actors in SWF
DSS/ Order Filler

Modality PS in Progress [6]

Modality PS Completed [7]
Procedure Scheduled [4]
Image Availability Query [11]
Procedure Updated [13]
DICOM Actors:
Creator PS in Progress [20] Performed Work Status Update [42]
Creator PS Completed [21] Performed Work Status Update [42]
DSS / Order Filler
Evidence Creator Image Display
Creator PS in Progress [20]
Creator PS Completed [21] PPS Manager
Storage Creator Images
Performed
Procedure
Commitment [10] Stored [18] Query Images [14]
Retrieve Images [16] Image Manager /
Step Manager
Archive
Image Image

Acquisition Modality
Manager Archive
Modality PS in Progress [6]
Modality PS Completed [7]
Creator PS in Progress [20]
Creator PS Completed [21]
Storage
Commitment [10]
Modality Image Stored [8] Evidence Creator
Modality PS in Progress [6]
Modality PS Completed [7]
Image Display
Acquisition
Modality
Modality Worklist Provided [5]

Sept 13-15, 2004 21 IHE Interoperability Workshop

 Acquisition Workflow Management

DSS/ Order Filler

Procedure Scheduled [4]
Modality PS in Progress [6] Image Availability Query [11]
Modality PS Completed [7]
Creator PS in Progress [20]
Creator PS Completed [21]
Procedure Updated [13]
Performed Work Status Update [42]
Performed Work Status Update [42]
DICOM:
Creator PS in Progress [20]
Evidence Creator Image Display
Modality Worklist
Creator PS Completed [21]
Storage Creator Images
Management (MWL)
Performed Commitment [10] Stored [18] Query Images [14]
Procedure
Step Manager
Retrieve Images [16]
Modality Performed
Image Image Procedure Step (MPPS)
Manager Archive
Modality PS in Progress [6]
Modality PS Completed [7]
Creator PS in Progress [20]
Creator PS Completed [21] Storage Modality Image Stored [8]
Commitment [10]

Modality PS in Progress [6]

Modality PS Completed [7]
Acquisition
Modality
Modality Worklist Provided [5]

Sept 13-15, 2004 22 IHE Interoperability Workshop

 Image Management
DSS/ Order Filler
Procedure Scheduled [4]
Modality PS in Progress [6] Image Availability Query [11]
Modality PS Completed [7] Procedure Updated [13]
Creator PS in Progress [20]
Creator PS Completed [21]
Performed Work Status Update [42]
Performed Work Status Update [42] DICOM:
Evidence Creator Image Display
Creator PS in Progress [20]
Creator PS Completed [21] Image Storage
Storage Creator Images
Performed
Procedure
Commitment [10] Stored [18] Query Images [14]
Retrieve Images [16] Storage Commitment
Step Manager

Image Image
Query/Retrieve
Manager Archive
Modality PS in Progress [6]
Modality PS Completed [7]
Creator PS in Progress [20]
Creator PS Completed [21] Storage Modality Image Stored [8]
Commitment [10]

Modality PS in Progress [6]

Modality PS Completed [7]
Acquisition
Modality
Modality Worklist Provided [5]

Sept 13-15, 2004 23 IHE Interoperability Workshop