1IHE Workshop – June 2006 What IHE Delivers

Cynthia A. LevyCynthia A. Levy Cedara Software Cedara Software

IHE Technical CommitteeIHE Technical Committee

Import Reconciliation Import Reconciliation Workflow ProfileWorkflow Profile

2IHE Workshop – June 2006IHE Workshop – June 2006

Import Reconciliation WorkflowImport Reconciliation WorkflowProblem StatementProblem Statement

The Problem:The Problem: A Healthcare enterprise is A Healthcare enterprise is presented with portable patient data (CD, presented with portable patient data (CD, Film) from unknown external sources. The Film) from unknown external sources. The Healthcare enterprise wishes to reconcile Healthcare enterprise wishes to reconcile patient and study data, and then import patient and study data, and then import this data into the patient’s electronic this data into the patient’s electronic health record (EHR).health record (EHR).

3IHE Workshop – June 2006IHE Workshop – June 2006

Import Reconciliation WorkflowImport Reconciliation WorkflowProblem Problem IssuesIssues

Physical LimitationsPhysical Limitations

Security/Administrative: no CD drive in medical workstationsSecurity/Administrative: no CD drive in medical workstations

Logistical LimitationsLogistical Limitations

Portable Data may include different user interfaces in viewers, Portable Data may include different user interfaces in viewers, some viewers don’t worksome viewers don’t work

The clinician’s need to archive images temporary or permanent The clinician’s need to archive images temporary or permanent can’t be fulfilledcan’t be fulfilled

Images not available in Radiology PACS for comparison or second-Images not available in Radiology PACS for comparison or second-opinion consultopinion consult

Data LimitationsData Limitations

Patient not registered in the HIS Patient not registered in the HIS

Patient not registered in the RISPatient not registered in the RIS

4IHE Workshop – June 2006IHE Workshop – June 2006

Import Reconciliation WorkflowImport Reconciliation WorkflowUse Case – External Acquisition/ReadUse Case – External Acquisition/Read

Radiology Enterprise A

Radiology Enterprise B

Provider A

Radiology Site B

PACS A

Portable Data Creator Patient Data

2. Radiology Site B creates portable media with patient images and/or Reports

1. Provider A orders External Radiology Procedure

3. Portable Media is sent to Reading Site A via CD. Patient Data is imported and read.

4. Study Results sent to Provider

Radiologist

PDI Disk

5IHE Workshop – June 2006IHE Workshop – June 2006

Radiology Enterprise B

Radiology Enterprise A

PACS B

Portable Data Creator

Patient Data

2.Relevant Data (including film) is collected and Enterprise A creates portable media with patient’s radiology information.

1. Request for Patient’s case data to be transferred from Enterprise A to B.

3.Data is transported to Site B via CD. Patient Demographics are reconciled and data is imported into archive.

4. Patient Data is now associated with B’s electronic health record system.

Import Reconciliation WorkflowImport Reconciliation WorkflowUse Case – Patient Referral/TransferUse Case – Patient Referral/Transfer

6IHE Workshop – June 2006IHE Workshop – June 2006

Import Reconciliation WorkflowImport Reconciliation WorkflowValue propositionValue proposition

Reading and Care Planning Efficiency: easy, dispersed, in context, access to patient’s data with the familiar user interface by all physicians in the healthcare enterprise.

Reduced Cost:no need for training to use new viewers.

Quality/Safety:patient and image identifiers are available and consistent

Handling Efficiency:reduced handling effort in the patient’s data for importing process.

7IHE Workshop – June 2006IHE Workshop – June 2006

Import Reconciliation WorkflowImport Reconciliation WorkflowScopeScope

Import Reconciliation Workflow (IRWF) piggy-backs on Scheduled Workflow (SWF)

Import of Evidence Objects regardless of transport mechanism Hardcopy Import (e.g. Films, Documents) Existing Evidence Objects (e.g. CDs, Network)

Improved Demographic Integrity Enterprise Patient/Order Information is used to identify

the Evidence Objects Original Patient Demographics are preserved within

resultant Evidence Objects

8IHE Workshop – June 2006IHE Workshop – June 2006

Import Reconciliation WorkflowImport Reconciliation WorkflowRequirementsRequirements

Patient must be registered in the HIS Patient Demographics from the Enterprise must be

used to reconcile imported data

Import may be a Scheduled Order Order information may be used to schedule the import Order information may be used to reconcile imported

data

Import may be Unscheduled

9IHE Workshop – June 2006IHE Workshop – June 2006

Import Reconciliation WorkflowImport Reconciliation WorkflowOut of ScopeOut of Scope

UnregisteredPatient

This scenario requires proper Patient Registration occur in all of the relevant Systems – HIS, RIS, PACS…

10IHE Workshop – June 2006IHE Workshop – June 2006

Import Reconciliation WorkflowImport Reconciliation WorkflowActors/GroupingsActors/Groupings

IRWF introduces one new Actor - Importer

The Importer is transport independent, and may need to be grouped: Portable Media Importer may be grouped with the

Importer to complete the import of Evidence Objects from a PDI CD

No grouping is necessary to import Films using a Digitizer.

11IHE Workshop – June 2006IHE Workshop – June 2006

Import Reconciliation WorkflowImport Reconciliation WorkflowOptions – and NotOptions – and Not

The Importer must implement at least one of the following options Scheduled Import Unscheduled Import

Additionally, the Importer may support Billing and Material Management

But Import PPS Exception Management

is required in IRWF

12IHE Workshop – June 2006IHE Workshop – June 2006

Import Reconciliation WorkflowImport Reconciliation Workflow

Scheduled Import Option

13IHE Workshop – June 2006IHE Workshop – June 2006

Import Reconciliation WorkflowImport Reconciliation WorkflowScheduled Import Scheduled Import

Scheduled Import Option supports scheduling of the import. The DICOM Modality Worklist provides information to the Importer about: Enterprise Patient Demographics

• Critical Attributes such as the Patient Name, Patient ID, Patient Birth Date and Patient Sex

• Other Patient Ids should be a merge of the Enterprise and Imported Object

Enterprise Order Information• Critical Attributes such as the Accession Number

14IHE Workshop – June 2006IHE Workshop – June 2006

Import Reconciliation WorkflowImport Reconciliation Workflow Transaction used for Scheduled Import Transaction used for Scheduled Import

RAD-5 Query Modality Worklist provides Patient Demographics and Order information for Scheduled Import and has been enhanced to include Scheduled Procedure Step Description may

include instructions on what should be imported Scheduled Procedure Sequence may include

instructions on the subsequent use of the instances

15IHE Workshop – June 2006IHE Workshop – June 2006

Import Reconciliation WorkflowImport Reconciliation WorkflowScheduled Import DependenciesScheduled Import Dependencies

IRWF depends on Scheduled Workflow

Required Actors for Scheduled Import are: Department Scheduler System/Order Filler Image Manager/Image Archive Performed Procedure Step Manager Importer

16IHE Workshop – June 2006IHE Workshop – June 2006

Import Reconciliation WorkflowImport Reconciliation WorkflowScheduled Import Transaction DiagramScheduled Import Transaction Diagram

Imported Objects Stored [RAD-61]

Storage Commitment [RAD-10]

Query Modality Worklist [RAD-5]

Performed Procedure

Step Manager

Import PS in Progress [RAD-59] Import PS Completed [RAD-60]

Import PS in Progress [RAD-59] Import PS Completed [RAD-60]

Import PS in Progress [RAD-59] Import PS Completed [RAD-60]

Importer

Image Manager

Image Archive

DSS/Order Filler

17IHE Workshop – June 2006IHE Workshop – June 2006

Import Reconciliation WorkflowImport Reconciliation Workflow

Unscheduled Import Option

18IHE Workshop – June 2006IHE Workshop – June 2006

Import Reconciliation WorkflowImport Reconciliation WorkflowUnscheduled Import Unscheduled Import

Unscheduled Import Option supports ad hoc importing. An HL7 Patient Demographics Supplier provided to the Importer about Patient Demographics: Critical Attributes such as the Patient Name

(PID:5), Patient ID (PID:3), Patient Birth Date (PID:7) and Patient Sex (PID:8)

Other Patient Ids (PID:4) should be a merge of the Enterprise and Imported Object

19IHE Workshop – June 2006IHE Workshop – June 2006

Import Reconciliation WorkflowImport Reconciliation Workflow Transaction used for Unscheduled Import Transaction used for Unscheduled Import

ITI-21 Patient Demographic Query provides Patient Demographics for Unscheduled Import

20IHE Workshop – June 2006IHE Workshop – June 2006

Import Reconciliation WorkflowImport Reconciliation WorkflowUnscheduled Import DependenciesUnscheduled Import Dependencies

IRWF depends on Scheduled Workflow

IRWF depends on IT Infrastructure Patient Demographics Query for Unscheduled Import

Required Actors for Unscheduled Import are: Patient Demographics Supplier Image Manager/Image Archive Performed Procedure Step Manager Importer

21IHE Workshop – June 2006IHE Workshop – June 2006

Import Reconciliation WorkflowImport Reconciliation WorkflowUnscheduled Import Transaction DiagramUnscheduled Import Transaction Diagram

22IHE Workshop – June 2006IHE Workshop – June 2006

Import Reconciliation WorkflowImport Reconciliation Workflow

With IRWF, Data Reconciliation is done as part of

the Process

23IHE Workshop – June 2006IHE Workshop – June 2006

Import Reconciliation WorkflowImport Reconciliation Workflow Import Critical Attributes Import Critical Attributes

Critical Patient Demographics and Order Information Attributes come from the Enterprise

Critical Study attributes must be maintained from the Imported Objects including: Study Instance UID (when valid) Referenced Study Sequence Scheduled Protocol Code Sequence

24IHE Workshop – June 2006IHE Workshop – June 2006

Import Reconciliation WorkflowImport Reconciliation Workflow Import Attribute Difference Import Attribute Difference

The actual mapping of attributes into the Resultant IODs and the MPPS depends upon the scenario: Digitized Evidence Objects such as Films will need to be

provided Study Instance UIDs and may not contain Original Patient Demographics (unless manually provided)

Digital Evidence Objects imported using Scheduled import may contain difference in the Resultant IODs versus the MPPS

And more…

See RAD-TF:2 Appendix A for all Attribute Mapping

25IHE Workshop – June 2006IHE Workshop – June 2006

Import Reconciliation WorkflowImport Reconciliation WorkflowOriginal Import AttributesOriginal Import Attributes

All Attributes modified during the Import shall be maintained using Original Attribute Sequence

A new Original Attribute Sequence is added every time DICOM objects are imported.

Original attributes from digitized hardcopy may be manually entered.

26IHE Workshop – June 2006IHE Workshop – June 2006

Import Reconciliation WorkflowImport Reconciliation WorkflowContributing Equipment AttributesContributing Equipment Attributes

The Contributing Equipment Sequence is used to maintain information about the Importing Equipment. Type of Equipment used to perform the import Institution performing the import …

27IHE Workshop – June 2006IHE Workshop – June 2006

Import Reconciliation WorkflowImport Reconciliation WorkflowCommon IRWF TransactionsCommon IRWF Transactions

The following transactions are required to complete the import: RAD-59 Import Procedure Step In Progress is

used to indicate that a Import is in-progress RAD-60 Import Procedure Step Completed is used

to indicate that a Import has been completed RAD-61 Imported Objects Stored is used to store

the Imported Evidence Objects RAD-10 Storage Commitment ensures Imported

Objects are stored

28IHE Workshop – June 2006IHE Workshop – June 2006