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Scheduled Workflow

This vendor workshop profile discusses the scheduled workflow concept for radiology orders, addressing areas such as registration, scheduling, acquisition workflow, and image content. It aims to improve order continuity, demographic integrity, workflow efficiency, order tracking, and reduce integration effort at sites. The profile also maps out the workflow structure and identifies the HL7 actors involved.

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Scheduled Workflow

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  1. Scheduled Workflow The First Profile Kevin O’Donnell, Toshiba Co-chair, IHE Planning Committee Vendor Workshop, April 2003

  2. Profile Summary • Genesis 1: In the beginning, … [ or better yet ] • Genesis 11: Tower of Babel • “and there confound their language, that they may not understand one another's speech. “ Vendor Workshop, April 2003

  3. Profile Summary • Fundamental Starting Point of IHE • Addresses Registration, Scheduling, Acquisition Workflow and Image Content • Bridges HL7 and DICOM Spaces Vendor Workshop, April 2003

  4. 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 Vendor Workshop, April 2003

  5. 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 Vendor Workshop, April 2003

  6. 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 Vendor Workshop, April 2003

  7. Scheduled Workflow Profile report Registration Film Lightbox Image Manager & Archive Orders Filled Film Folder Diagnostic Workstation Film Report Repository Orders Placed AcquisitionModality acquisitioncompleted acquisitionin-progress imagesprinted Modality acquisitioncompleted Vendor Workshop, April 2003

  8. IHE Workflow Concepts IHE has selected three UNAMBIGUOUS HL7/DICOM TERMS : 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’ ORDER : A request for radiologic service REQUESTED PROCEDURE : A Unit of work resulting in one Report (with associated codified, billable acts) Vendor Workshop, April 2003

  9. CLINICIANOR REFERING DOC:The Imaging Dept Customer RADIOLOGIST : In Charge of producing theReport TECHNOLOGIST(and RADIOLOGIST)In charge of acquiring images, etc. Workflow Concept Mapping This 3 level workflow structureis useroriented: ORDER:A request for imaging service (Accession Number) REQUESTED PROCEDURE : Units of work resulting in one Reportwith associated codified, billable acts(Requested Procedure ID) PROCEDURE STEP :The smallest unit of workin the workflow (modality worklist entry) Vendor Workshop, April 2003

  10. DICOMModality Worklist ScheduledProcedure Step One or more series of images PerformedProcedure Step AcquisitionModality Normal Workflow Typical workflow: One Order – One Procedure – One Report Radiology Department ORDER A request for RadiologicService Set of Codifiable, Billable, Acts Report Requested Procedure Vendor Workshop, April 2003

  11. DICOMModality Worklist ScheduledProcedure Step A Report ScheduledProcedure Step B One or more series of images One or more series of images DICOMModality Worklist PerformedProcedure Step P1 PerformedProcedure Step P2 AcquisitionModality AcquisitionModality Multiple Modality Steps Radiology Department ORDER A request for RadiologicService Set of Codifiable, Billable, Acts Requested Procedure 1 Vendor Workshop, April 2003

  12. “HL7 Actors” in SWF HL7 Actors: • ADT/Patient Registration • Order Placer • DSS / Order Filler • Image Manager Vendor Workshop, April 2003

  13. ADT Actor Primary Patient Info Entry Vendor Workshop, April 2003

  14. ADT Transactions 4.1 - Patient Registration • Send • Admit: A01 (In Patient), A04 (Out Patient), A05 (Pre-Admission) • Cancel: A11 (Cancel Admit), A38 (Cancel Preadmit) 4.12 - Patient Update • Send • Transfer: A02 (Patient Transfer) • Update Patient Class: A03 (Discharge), A06(Outpatient becomes Inpatient), A07 (Inpatient becomes Outpatient) • Update Patient Information: A08 (Update) • Merge Patients: A40 (Merge) • Cancel: A12 (Cancel Transfer), A13 (Cancel Discharge) Vendor Workshop, April 2003

  15. Order Placer Actor Primary Order Entry Vendor Workshop, April 2003

  16. Order Placer Transactions 4.2 - Placer Order Management • Send • New Order: ORM/NW (New Order) • Cancel: ORM/CA (Cancel Order), ORM/DC (Discontinue) 4.1 - Patient Registration • Receive 4.12 - Patient Update • Receive 4.3 - Filler Order Management • Receive Vendor Workshop, April 2003

  17. Department System Scheduler / Order Filler Actor Primary Scheduling & Order Management Vendor Workshop, April 2003

  18. DSS/Order Filler Transactions 4.3 - Order Filler Management • Send • New Order: ORM/SN (New Order) • Order Status: ORM/SC (Status Change) • Cancel: ORM/OC (Cancel Order) 4.4 - Procedure Scheduled • Send • ORM (procedure scheduled) 4.13 - Procedure Updated • Send • ORM (procedure updated) Vendor Workshop, April 2003

  19. DSS/Order Filler (Cont.) 4.1 - Patient Registration • Receive 4.12 - Patient Update • Receive 4.2 - Placer Order Management • Receive Vendor Workshop, April 2003

  20. “DICOM Actors” in SWF DICOM Actors: • DSS / Order Filler • PPS Manager • Image Manager /Archive • Acquisition Modality • Evidence Creator • Image Display Vendor Workshop, April 2003

  21. Acquisition Workflow Management DICOM: • Modality Worklist Management (MWL) • Modality Performed Procedure Step (MPPS) Vendor Workshop, April 2003

  22. Image Management DICOM: • Image Storage • Storage Commitment • Query/Retrieve Vendor Workshop, April 2003

  23. Additional Workflow Management HL7: • ORM Message DICOM: • Query (C-FIND) • Modality Performed Procedure Step (MPPS) Vendor Workshop, April 2003

  24. Some Transaction Details 4.5 - Modality Worklist Provided • DSS/Order Filler is Responsible for translating HL7 orders into DICOM Worklist 4.6 - Modality PPS In-Progress 4.20 – Creator PPS In-Progress • MPPS N-Create (Start), N-Set (Updates) 4.7 - Modality PPS Completed 4.21 – Creator PPS Completed • MPPS N-Set (Complete) 4.11 - Image Availability Query • C-FIND (Study Root Query, Hierarchical) 4.42 - Performed Work Status Update • N-SET (Complete) Vendor Workshop, April 2003

  25. Administrative Normal Process Flow Vendor Workshop, April 2003

  26. Procedure PerformanceNormal Process Flow Vendor Workshop, April 2003

  27. Assisted Protocol Setting Option • Motivation • Reduce variance on how procedures are performed • Centralize configuration effort • Mechanism • Order Filler/DSS passes Protocol Codes to the Acquisition Modality inside the Worklist Item Vendor Workshop, April 2003

  28. PPS Exception Management Option • Motivation • Provide better feedback on discontinued studies • Handle selection of wrong worklist item • Mechanism • Code (0008,0104) Vendor Workshop, April 2003

  29. Code Meaning (0008,0104) 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 Discontinue Reason Codes Vendor Workshop, April 2003

  30. SWF Synergies • Additional Content Profiles • Workflow can manage creation of other objects • Post-Processing Workflow • SWF Status can trigger Post-Processing • SWF Output can be input to Post-Processing • Reporting Workflow • SWF Status can trigger Reporting • SWF Output can be input to Reporting • Charge Posting • SWF Status can trigger/feed Billing • Presentation of Grouped Procedures • Specializes SWF for Grouped Procedures Vendor Workshop, April 2003

  31. References • Profile - Volume 1, Chapter 3 • Transactions - Volume 2 • Note Vol. 2, Appendix A, B – Attribute Mapping Vendor Workshop, April 2003

  32. Patient Information Reconciliation Expect the Unexpected Vendor Workshop, April 2003

  33. Profile Summary • Extension of existing profile • Coordinates update of demographic information in workflow and content objects Vendor Workshop, April 2003

  34. Motivation • Handle “exception” cases • Trauma/Emergent Cases • Patient Unknown or no time for Registration • Entry Errors by Operator • Other Demographic Changes • (e.g. married name) • Multiple sources/destinations for updates • High risk of unsynchonized/inconsistent data • Workflow must continue • Need to pull together past & current patient records Vendor Workshop, April 2003

  35. Use Cases • Local policy calls for ADT to pre-register ER patients (“John Doe”, “Jane Doe”): • Case 1: Unidentified Patient registered at ADT and order is placed at Order Placer. • Case 2: Unidentified Patient registered at ADT and order is placed at DSS/Order Filler. • Case 3: Unidentified Patient registered at ADT but acquisition completed at Modality prior to order. Vendor Workshop, April 2003

  36. Use Cases • Local policy allows departments to register ER patients with Departmental IDs: • Case 4: Unidentified Patient assigned temporary Departmental ID and scheduled at DSS/Order Filler. • Case 5: Image Acquisition completed prior to assigning temporary Departmental ID or Order (Patient ID entered at the Modality). Vendor Workshop, April 2003

  37. Department System Image Order ADT Database/Scheduler/ Manager Placer Modality Order Filler Register J.Doe Patient Registration [1] Placer Order Mgmt NewOrder [2] Schedule Procedure Procedure Scheduled [4] Images Acquired MWL Provided [5] Modality Procedure Modality Procedure Step Completed [7] Step Completed [7] Patient Reconciliation J.Doe -> J.Smith Patient Patient Update [12] Update [12] Unidentified Patient - Case 1 Vendor Workshop, April 2003

  38. Department System Image Order ADT Database/Scheduler/ Manager Placer Modality Order Filler Register J.Doe Patient Registration [1] Filler Order Mgmt New Order[3] Schedule Procedure Procedure Scheduled [4] Images Acquired MWL Provided [5] Modality Procedure Modality Procedure Step Completed [7] Step Completed [7] Patient Reconciliation J.Doe -> J.Smith Patient Patient Update [12] Update [12] Unidentified Patient - Case 2 Vendor Workshop, April 2003

  39. Department System Image Order ADT Database/Scheduler/ Manager Placer Modality Order Filler Register J.Doe Patient Registration [1] Filler Order Mgmt New Order [3] Schedule Procedure Procedure Scheduled [4] Images Acquired Modality Procedure Modality Procedure Step Completed [7] Step Completed [7] Patient Reconciliation J.Doe -> J.Smith Patient Patient Update [12] Update [12] Unidentified Patient - Case 3 Vendor Workshop, April 2003

  40. Department System Image Order ADT Database/Scheduler/ Manager Placer Modality Order Filler Register J.Smith Patient Registration [1] Filler Order Mgmt New Order [3] Schedule Procedure for J.Doe Procedure Scheduled [4] Images Acquired MWL Provided [5] Modality Procedure Modality Procedure Step Completed [7] Step Completed [7] Patient Reconciliation J.Doe -> J.Smith Patient Update [12] Unidentified Patient - Case 4 Vendor Workshop, April 2003

  41. Department System Image Order ADT Database/Scheduler/ Manager Placer Modality Order Filler Register J.Smith Patient Registration [1] Filler Order Mgmt New Order [3] Schedule Procedure Procedure Scheduled [4] Images Acquired for J.Doe Modality Procedure Modality Procedure Step Completed [7] Step Completed [7] Patient Reconciliation J.Doe -> J.Smith Patient Update [12] Unidentified Patient - Case 5 Vendor Workshop, April 2003

  42. Questions,Comments,and/orSuggestions? Vendor Workshop, April 2003

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