; Master Cath Comments_3.xls - IHE
Learning Center
Plans & pricing Sign in
Sign Out
Your Federal Quarterly Tax Payments are due April 15th Get Help Now >>

Master Cath Comments_3.xls - IHE


  • pg 1
									Specific Name of       Level of Comment
Section # Person       Severity
          Submitting   (high-
          (optional)   serious
                       or low -
3        CAL           high      Requested Procedure is defined as
                                 resulting in one or more reports.
                                 Radiology TF and Departmental
                                 Whitepaper have a Requested
                                 Procedure resulting in a single Report.

3        CAL           high       Technical Committee Discussion Due
                                  to the way Cath is scheduled, the PIR
                                  Profile has been integrated into to the
                                  Scheduled Workflow. The presentation
                                  provides one flow with all of the cases.

3        GE_CP         mid        In the following paragraph: Although
                                  the major cases for cath workflow are
                                  described in the following subsections,
                                  it is beneficial to also see the
                                  corresponding workflows in radiology.
                                  Rad TF-1: 3.3 has a description of the
                                  “normal” scheduled workflow when all
                                  three levels of control in the data model
                                  are fully utilized for known patients, and
                                  Rad TF-1: 4.3 and 4.4 describes
                                  workflows when the patient is unknown
                                  and/or the ordering and scheduling
                                  process is short-circuited (e.g., in the
                                  emergency case). It seemed to be
                                  implied that the three levels are
                                  not”used” in special cases. This is
                                  wrong. They are always present and
                                  used, however, not to their full extend.

3.2      Teri Sippel   high       OK, remind me, why is Patient Based
                                  Worklist Query "O" for optional?
                                  Throughout the use cases we talk
                                  about a patient wrist band/scanner.
                                  Why not require it for all modalities?

3.2      CAL           mid        In the Rad TF this section talked about
                                  additional options available within
                                  Scheduled Workflow. In Cardio some
                                  of the “OPTIONAL” options are
                                  required, bu there are some
3.2   CAL        high   Technical Committee Discussion: Is it
                        reasonable for optional scheduled
                        workflow items to become required? It
                        is certainly true that things work better
                        if everything is automated, but is the
                        bar being set too high?
3.2   agfa-pas   low    Table 3.2-1: What does it mean for an
                        "option" to be "required"? The
                        'Optionality' column in table 3.2-1
                        makes this "options" table inconsistent
                        with the options tables in the other
                        frameworks. (Same comment applies
                        to table 4.2-1 in section 4.2).

3.3   CAL        high   Paragraph labeled: Modality Procedure
                        Step In Progress and Update
                        Schedule:MPPS In Progress is
                        behaving completely different then the
                        Radiology MPPS In Progress.
                        Radiology MPPS In Progress would
                        treat the procedure as
                        “Unscheduled”.The process for
                        updating the rest of the schedule would
                        then be out of scope for IHE.I don’t
                        even think the current DICOM MPPS
                        will allow the MPPS N-Create and
                        resulting N-Set parameters to work as

3.3   CAL        high   Paragraph labeled Query Modality
                        Worklist: Why is it a requirement that a
                        Broad Query be done in order to make
                        the process work? Either query may
                        work, it depends on the way the
                        Systems work.
3.3   CAL        mid    Paragraph labeled Perform Acquisition:
                        Re-word the last sentence in the
                        paragraph “The Image
                        Manager/Archive must support all
                        these object types beyond just images”
3.3   CAL          mid    Paragraph labeled Modality Procedure
                          Step Complete: The text in this
                          paragraph is not sufficient to explain
                          how the MPPS Complete is used.
                          Additional information is required along
                          with how the DISCONTINUED status is
                          used. Please clarify the statement “It is
                          up to the DSS/OF to determine when
                          the modality resources in the room are
                          available for another procedure”.

3.3   CAL          mid    Paragraph labeled Storage
                          Commitment:The requirement stated in
                          this paragraph is no different from the
                          RAD TF Storage Commitment.
3.3   Camtronics          In the bullet point starting with “Modality
                          Procedure Step In Progress…”: A
                          “modality ID” is referred to.

3.3   GE_CP        low    The use of the word attribute is
                          surprising in Volume 1 in : “so there
                          needs to be a way for all of the
                          participating modalities to coordinate
                          and to share attributes.”
3.3   GE_CP               The title of this section should be Cath
                          Scheduled Workflow. There are many
                          additions to the radiology scheduled
                          workflow, so it needs to be just part of
                          Cath Workflow.
3.3   TDO          high   Paragraph labeled: Modality Procedure
                          Step In Progress and Update
                          We talk about "starting" a procedure -
                          but there is no discussion on how the
                          DSS would know when not to provide
                          the current procedure to a modality
                          using a broad-query.We have to avoid
                          a broad-query resulting in the incorrect
3.3   agfa-sg       high   The "Start Procedure" activity that is
                           performed by the Order Filler does not
                           seem to make sense in these workflow
                           scenarios. Who benefits from this
                           activity? The information is not
                           propogated to any other systems. It
                           appears to be an activity that is only
                           used by the Order Filler, so I don't
                           know that it belongs in the IHE
                           Framework. (In addition, this is the
                           only status event, e.g. there is no "End
3.3   smm                  Under Create Order: The Order Placer
                           is the enterprise repository for all
                           patient orders.
3.3   Teri Sippel   high   3rd para under IHE Context which
                           begins with "Note that the transactions
                           for Modality Image…" : This sentence
                           is actually quite important but is easily
3.3   Teri Sippel   high   The MPPS transactions for the "N"
                           modalities in all of the following use
                           case diagrams are not shown but
                           nowhere does it say that these
                           transactions are implied.

3.3   CAL           mid    Discussion on grouping of PPS Mgr
                           should be re-worded. First it is stated
                           that it is presumed grouped with the IM,
                           and then the text goes on to talk about
                           alternative groupings.

3.3   Teri Sippel   high   In echo, PPS Exception Mgr is optional
                           Rad-TF 2: 4.7. I think it should be at
                           least optional for cath as well, if not
3.3   Teri Sippel   low    case # does not appear in Figure titles
                           as it does in Echo use cases
3.3   Camtronics           IHE-Rad SWF shows Transactions 11
                           and 42 between the DSS/OF and the
3.3   Camtronics           IHE-Rad SWF has Transactions 11
                           and 42 in the DSS/OF actor and
                           Transactions 11 and 42 in the IM/IA
3.3   Camtronics           IHE-Rad PIR has Transaction 12 in the
                           IM/IA actor.
3.3         Teri Sippel    low    transactions in figures are lower case,
                                  but transactions in text are upper case
                                  (eg, CARD-1)
3.3         Rick Bennett   mid    Many of these transaction diagrams
                                  have image manager and image
                                  archive as essentially a single entity.
                                  I'd prefer to see them separated, with
                                  the image manager actor having the
                                  transactions with image display and
                                  acquisition modality.
3.3         Teri Sippel    high   Image Manager/Archive is missing a
3.4         GE_CP          low    This table is confusing because it
                                  achieves two purposes. First to select
                                  options from CLW for applicability into
                                  CARD-SWF. Second it list which the
                                  option that an implementor of CLW
                                  may chose to support. This needs to
                                  be presented in a two step process.

3.4         CAL            low    Differences between Rad and Cath are
                                  shown in color. Not everyone has
                                  access to color printers

3.4         GE_CP          mid    The definition of start procedure is very

3.4         GE_CP                 In the bullet modality procedure step
                                  started, the sentence: “If the DSS/OF
                                  has not started the procedure, upon
                                  receipt of first MPPS In Progress for
                                  the Cath Lab, which includes the
                                  patient ID/name and the modality ID”
                                  Uses the term Modality ID. Why
                                  introducing a new term is it AE Title or
                                  Station ID ?
3.4         GE_CP                 In Query Modality Worklist bullet, why
                                  these wishy washy terms of may,
                                  would, Is there one and only one in that
                                  case or not ?
3.1 – Fig   GE_CP                 In the Storage commitment bullet, why
3.1-1                             use only “must” and not “shall” in
                                  relationship to the support of mobile
3.1 – Tab Teri Sippel      mid    Table of use cases is misleading…
3.1-1                             clinical folks will think we are dreaming.
3.1 – Tab Teri Sippel    mid       what does the Note apply to?
3.1-1     CAL            mid       IHE Context: Case2 is currently
                                   supported by RAD Scheduled
3.1-1 Fig   agfa-pas     low       IHE Context: Might be useful to
                                   reference the cases from the Rad-SWF
                                   and Rad-PIR profiles which are
                                   covered by this case
3.1-1 Tab Teri Sippel    high      2nd para in IHE Context: should it say
3.1-1                              something about using a 'generic'
                                   procedure code (I know it is covered in
                                   Vol 2).
3.2.1 Tab CAL            high      C3 -Regarding the Auto-create
                                   Procedure How does the DSS/OF
                                   know when an MPPS N-Create
                                   (unscheduled procedure) is the start of
                                   a new case?
3.3 Fig 3.3-TDO          grammar   Note - the differences between the
1                                  radio and cardio TF should be bulleted
                                   for effect
3.3 p26     Camtronics             In the bullet point starting with “Using
                                   the information from the MPPS
                                   transaction…”: A “modality station
                                   name” is referred to.
3.3 p27     TDO          grammar   the explanation of the working of the
                                   MPs in progress is simikar to the
                                   discussion in 3.3 above
3.3 p27     agfa-sg      mid       When the Order Filler auto-creates the
                                   procedure (upon receiving MPPS In
                                   Progress), the other modalities will the
                                   other        modalities        use       the
                                   study_instance_uid that was supplied
                                   by the first modality? I would assume
                                   that would be the case, and the order
                                   filler would not generate a new one -
                                   otherwise the images on the archive
                                   would have a different study than the
                                   order filler. If this is the case, it should
                                   be clearly described in this use case. If
                                   it isn't, then details about how the
                                   images get synced up with the order
                                   filler should be described.

3.3 p27     CAL          high      C4 – Emergency Patient with
                                   Procedure Ordered The workflow
                                   defined here is normal except for the
                                   fact that PIR is required.
3.4 table   agfa-sg       mid    I think that the Order Placer should get
3.4-1                            the order status update sent to it from
                                 the filler order at the end of this use
                                 case (Patient Registered at DSS/OF
                                 and Procedure Ordered). I don't
                                 believe      that    the       Filler   Order
                                 Management -            New transaction
                                 supports order status. However, the
                                 order status can be sent in the Order
                                 Managment Order Status Update
3.4 table   Teri Sippel   high   after fig 3.4-5 bullet 4 - it is kind of
3.4-1                            wimpy. Sounds like a recommendation,
                                 not a requiremetn.

3.4.1       agfa-sg       mid    I think that the Order Placer should get
                                 the order status update sent to it from
                                 the filler order at the end of this use
                                 case (Patient Not Registered). I don't
                                 believe      that    the    Filler   Order
                                 Management -           New transaction
                                 supports order status. However, the
                                 order status can be sent in the Order
                                 Managment Order Status Update
3.4.2       agfa-pas      mid    The first note under the IHE Context
                                 section discusses the possibility of a
                                 time lag between MPPS in-progress
                                 and availability of SPSs in the MWL.
                                 How frequent is this case? If frequent
                                 enough, not addressing it in this profile
                                 will limit the usefulness of the profile.

3.4.2       CAL           mid    C6 – Patient Update during Procedure.
                                 This is covered by PIR

3.4.3       Teri Sippel   low    clinical scenario' should be 'clinical
3.4.3       Teri Sippel   high   assumption of what is in a Requested
                                 Procedure is too naïve.

3.4.3       CAL           high   C7 – Change Room During
                                 ProcedureWhat information goes into
                                 the IOD headers, etc. Append is
                                 normally done on the same Modality. If
                                 the room change is to a different
                                 modality then what? (Same procedure,
                                 but different equipment)
3.4.3      agfa-sg         high   It appears as though this use case is
                                  asking modalities to pick procedures
                                  from a worklist, even if the procedure
                                  has not been scheduled for that
                                  particular modality. This seems to be
                                  something new that is being asked of
                                  the modalities. I think that in Year 2,
                                  the intent is to have the entire
                                  scheduling ownership in the order filler.
                                  I don't see any reason in Year 1 to
                                  have modalities add support for finding
                                  procedures that are scheduled on a
                                  different modality. I would suggest
                                  enforcing that the filler updates the
                                  scheduling information before the next
                                  modality performs a worklist query.

3.4.3      agfa-sg         mid    I don't understand why modality 1 and
                                  modality 2 can both be responsible for
                                  sending the MPPS Discontinued
                                  message. I think it would be more
                                  beneficial to just select the original
                                  modality or the target modality.

3.4.3     / Rick Bennett   low    I'd prefer to have a reminder in the
3.4.5                             legend of the figure as to what Case is
                                  being displayed. In this figure, simply
                                  say "Figure 3.4-5. C-5. Patient not
3.4.3,     GE-HS                  We especially need clarification
Page 33                           on:
3.4.4      GE-HS                  We need either a new section in
                                  this appendix, or another
                                  appendix, that discusses the use
                                  of various procedure and protocol
                                  codes for a diagnostic exam that
                                  evolves into an interventional
3.4.4      Camtronics             In Cases automatically created SPS be
                                  closed? If automatically created SPS
                                  be closed? If automatically created
                                  SPS’s are available for a long period of
                                  time, it seems like a procedure
                                  performed a day or so later (unrelated
                                  to the original order) may accidentally
                                  get associated with the original
3.4.5   KOD   high   Introducing Clinical Context vs IHE
                     Context is confusing when not
                     explained, and mixing references to the
                     SWF profile in the Clinical Context
                     further confuses the intent.

3.4.5   KOD   low    Fig 3.3-1 implies that starting the
                     procedure on the DSS/OF somehow
                     triggers the worklist query from the
3.4.5   KOD   low    Schedule Procedure text implies that
                     assigning a time slot and equipment
                     are required

3.4.6   KOD   low    Query Modality Worklist text implies
                     that there is never more than one
                     procedure step scheduled for a patient.

3.4.6   KOD   low    Fig    3.3-2   doesn't  show         the
                     corresponding End Procedure.

3.4.7   KOD   low    Fig 3.3-2 should break the DSS/OF box
                     before the MWL Query.
3.4.7   KOD   low    Fig 3.3-2 implies that MPPS messages
                     cannot be sent directly to the DSS/OF

3.4.7   KOD   high   Update Status text says that Modality
                     ID is used to identify the room, but
                     elsewhere the Location attribute is
                     required for that purpose. Which is
                     true? What if they conflict? (Mobile
3.4.7   KOD   high   Update Status text says the DSS/OF
                     updates the Scheduled Procedure
                     Steps for all the modalities in that same
                     cath lab but does not define what that

3.4.7   KOD   low    Update Status text is more detailed
                     than the Start Procedure text.
3.4.7       KOD       high   Has the MPPS exception case where
                             the wrong worklist entry is selected and
                             an initial MPPS is sent been reviewed
                             in the context of using the active
                             procedure for room eqt coordination?

3.4-5 Fig   KOD       low    Fig 3.4-1 needs a break in the DSS
                             Boxes after the Start Procedure and
                             Update Procedure actions
App A       KOD       low    Fig 3.4-3 doesn't have a Start

App A       KOD       high   So the concensus is that it is preferable
                             in the Patient ID Update case for the
                             different equipment in the Cath Suite to
                             display         different         Patient

App A       KOD       high   The diagram does not show any
                             storage of images/etc from the
                             modalities. There could be confusion
                             about what should be stored, what is
                             stored, and what each system needs to
                             consider to make things that should
                             match match and things that should be
                             unique be unique.

General     GE-HS            PPS Mgr in figures: "... the Performed
                             Procedure Step Manager is not shown
                             on the Process Flow diagrams and is
                             presumed to be grouped with the
                             Image Manager."
            tsippel          There is another potential use case in
                             Cath. It is not clear to me that the
                             Change Rooms use case is teh correct
                             solution, but it may be. This case is the
                             "patient/case diverted to a different
                             room only seconds before patient
                             enters room" case. Needs more
tsippel   need a Procedure Cancelled Use Case

GE-HS     Table 3.2-1 should be "Cardiac Cath
GE-HS     Table 4.2-1 should be "Echo Workflow"

smm       Counting on DSS to schedule
          procedures is dangerous
smm     Cath workflow, room change

GE-HS   1. Whether an order for a
        Diagnostic Cath should be
        replaced by the DSS/OF with an
        order for a
        Diagnostic/Interventional Cath.
        2. How SPSs can be used - single
        SPS for Cath, separate SPSs for
        diagnostic and interventional, etc.

        3. How MPPSs can be used -
        either by completing the
        diagnostic PPS and starting a new
        interventional PPS, or by reporting
        both diagnostic and interventional
        Protocol Codes in a single PPS -
        and the implications of each
Proposed Resolution                        Propose as         Final Resolution if Accepted (to be filled in by
                                           Accepted/Rejecte Comment Editor)
                                           d (to be filled in
                                           by Comment

Need to understand why the Units of        Reject - Discuss at
work can’t be broken down so there is a    Rad TC 7/12/04 No
1-1 correspondence with the Number of      change needed to
Requested Procedures.                      Cardiology TF

Should the workflow be presented with a    Reject- Discuss at
PIR requirements overlay to keep things    Rad TC 7/12/04 No
consistent. The requirements of PIR        change needed to
appear to be consistent. There are just    Cardiology TF
more of them.

Reword the last sentence. This idea of Accept - change
not fully utilizing the three level is     Harry to work on
restated several time without being        rewording.
explained. I suggest that the three levels
are always used. No need to discuss in
Vol I the missing information (e.g. no
SPS) in some cases.

make it "R" in Table 3.2-1                 Reject

Divide this section into two sections to   Accept - elaborate
discuss portions of Scheduled Workflow     better in sec 3.2
which are required for Cath Workflow, or   (same change for
add verbiage into the section and          Echo 4.2)
rename the section and the table.
Is this discussion out of scope for the        Reject -
Public Comment? Propose that the               requirements are
optionally be maintained, but that             based on the
verbiage be used to indicate the               needs of cardiology
importance of their support.

Either remove the "optionality" column         Accept - elaborate
from the table or clearly explain what it      better in sec 3.2
means to have an "option" that's               (same change for
required.                                      Echo 4.2)

The following is a suggestion which            Reject This is not
would need to have all the elements            an unscheduled
worked through: Use the Scheduled              case it is a
Procedure as a “seed”, but then                scheduled case
discontinue and create an unscheduled          and is the same as
MPPS with the real parameters. These           Radiology
two elements could be used by the
DSS/OF to accomplish the scheduling of
the remaining pieces (how would again
be out of scope for IHE as it is internal to
a single actor). There are a number of
parameters (Requested Procedure,
Study UID, etc. which will need to be
specified to ensure that the links are all

Remove the strengthening requirement           Reject - not a
for Broad Query Support.                       requirement.
Recommendation would be acceptable.            "may" suggests it is
                                               an option.

The Image Manger/Archive must support          Reject -
all of the DICOM SOP Classes required          conformance to
to support the Cardiology Workflow. It is      Cath option is
expected that this be documented by a          required
reference in the IHE Integration
Statement (Appendix D of RAD TF Vol
Suggestion that the MPPS In-Progress         Accept - but text
and Complete section be put so that the      improved in regard
interaction between the start and            to multimodality
complete explain the entire interaction      completeness

Remove this section. If it is felt this is    Reject - needed in
critical to state, it can be placed in one of Card vol 1
the Use Cases.

Is this the “Performed Station Name”,        Accept - use
“Performed Station AE”, “Modality” or        Performed Station
something else?                              AE

Replace by: “so there needs to be a way      Accept - change
for all of the participating modalities to   patient and
coordinate and to share specific             procedure
information.”                                information

Change title of 3.3 to Cath Scheduled        Accept - change
Process Flow. And remove Case C1 in          name
3.4 which is almost entire duplication.

WE should advise that DSS provide a          Duplicate
means to indicate that the current           Start/Stop
procedure is "complete" wrt the              Improved in 3.3
acquisition modalities in that room. This    rewording
is no more than recognition of existing
functionality in most practical DSS
implementations.     Other     automated-
based alternatives via linking this to
generation of another "unexpected"
MPPs-in-progress (with another patient
ID) may be impractical, especially as the
number of cath-lab modalities and their
time-based interaction grows.
Remove this activity from the Framework Same start
or propogate it to other systems (only if it procedure
is needed by another system).                discussion -
                                             Improved in 3.3

I don't see how you can make this           Accept - remove
implementation statement.                   word enterprise

it should be an indented note (or a         Accept improved
separate para in bold) to set it off        text

I believe that there needs to be a       Accept
sentence immediately following the
sentence listed above which also states
"the MPPS transactions for the other "n"
modalities are not included in the
diagrams for the sake of simplicity…."

Re-word to indicate that only the process   Reject wording is
control workflow are shown in this          the same as RAD
section. Then specifically state that the   TF 4.4.1; There is
PPS is not shown because it is assumed      no critical grouping.
that it is grouped. Grouping was already
discussed. If there is something critical
about the grouping it should have been
stated in the transactions section.

make optional or required.                  Accepted - text

add use case # to figure titles             Accept

Why wouldn’t this be included for           Reject - part of
Cardiology?                                 reporting

Why wouldn’t this be included for           Reject - part of
Cardiology?                                 reporting

This is probably just an omission as the    Accept
transaction appears in Figure 3.1-1
make consistent, but is it worth it?       Accept - change

needs discussion. Should they be       Reject
seperated? Meaning a line should be
between Image Manager and Image
Archive because they could be separate

Add Patient Updated RAD 12 to the table Accept - change

Break this in two tables.                  Reject

Better to show differences using bold,     Reject
special text or lines (or some other
indicator) so it is visible in black and
white print.
                                           Accept - update
                                           clinical context of
                                           Accept - duplicate



Add a sentence immediately prior to        Accept - improve
table 3.4-1 which says something to the text 3.3 clinical
effect of "Today Case C3 and Case C5 context
are by far the most common. It is the
intent of this Profile to move towards the
Cases C1 and C2." or something more
delete it.                                 Reject

IHE Context: Case2 is currently            Reject - duplicate
supported by RAD Scheduled Workflow        of completeness
receive and cancel.
Reference the SWF 'order replacement       Accept - with
by the DSS/OF' case and PIR case #2.       reference

add sentence                               Accept - update
                                           use of Procedure
                                           codes in 3.4.3

Should there be the concept of a         Reject- Answered
standing Procedure (Temporary) just like in vol 2 sec 4.1.1
there is a standing Patient ID

bullet the two differences discussed.      Accept

Is this the “Performed Station Name” or    Accept - use
something else?                            Performed Station

put it in 1 place with an identifier and Reject
refer to it. Give it a special use-case.

Describe who      generates   the   study Reject
instance uid.

Provide a description of the workflow as   Reject - Specific to
a case. If necessary expand the PIR        Radiology
Profile to include all of the Cardiology
Add the order status update transaction Accept - also
to the end of this use case.            needed in cases 4
                                        and 5. Transaction
                                        also needed in

strengthen sentence by adding               Reject - has to be
something to the effect of 'all cases for   manual
patient reconciliation should be queued     reconciliation
(retained?) for future resolution.'

Add the order status update transaction Accept - also
to the end of this use case.            needed in cases 4
                                        and 5, others.
                                        Transaction also
                                        needed in RAD

                                            Accept - reword
                                            3.4.3 and 3.4.5
                                            notes by
                                            emphasizing that
                                            time lags are
                                            minimal - minutes
                                            not hours.

See comments above regarding the            Reject - single
structuring of PIR and Workflow.            profile in
change it.                                  Accept

in first para of IHE Context, last      Accept
sentence: add "…treated as a single
Requested Procedure, ie., the same
Study Instance UID."
Need to include concrete examples with Accept - add in
what information goes into the IODS and tables
the MPPS.
I would like a discussion of scheduling Reject - no
the procedures to take place in the case additional modality
where the patient may get moved to support is needed.
another room.

It would be nice if the the IHE Technical   Reject - timing is
Framework stated exactly which modality     not relevant, every
is responsible for sending the MPPS         modality has to
Discontinued message when a room            send a discontinue
change occurs.                              or complete before
                                            next case.

                                            Agreed. Quick fix.

                                            Accept - need
                                            more words for end
Explain that use cases will first present Accept
the "Clinical Viewpoint" to establish the
needs from a clinical users point of view,
then the "IHE Viewpoint" will present how
the situation is modelled in this technical
framework and what the solution is.
Consistency with this should be reviewed
in each Clinical/IHE section.

The Start Procedure should be          a Accept
separate box in the flow diagram.

Change Text to: Scheduled Procedure         Reject - must have
Steps are scheduled, i.e., placed on the    time and AE title
worklist, possibly with an assigned time    for MWL
slot    and/or    performing     resource
Change Text to: (provided with sufficient   Accept
query keys to get back the scheduled
procedures for a single patient)

Since Start Procedure was called out in Accept/Duplicate
the diagram, End Procedure should be
included too.

Add a note explaining that this diagram Accept
shows the IM receiving the MPPS
messages and forwarding to the DSS,
however it is also valid to send the
MPPS to the DSS and it will forward to
the IM.
Choose one an update text accordingly. Accept/Duplicate

Clarify what attributes of the SPSs must    Accept - need
be updated; where the updated values        elaboration
should come from; what to do if they
conflict with existing values; how the
DSS knows what modalities are in that
cath lab at this moment.
Consider using the "first MPPS triggers     Reject - point of
Start Procedure" as the base case then      fact start procedure
model the other as the manual or non-       happens
modality method to do the same thing.       significantly sooner
And make sure the above issues are still    than MPPS
If not, should review                         Accept - need
                                              reference to text
                                              within Radiology
                                              Management Sec
(And repeat for subsequent diagrams)          Accept

Since actions are identified with Start       Reject - C3 is
Procedure, it should be included unless       started by MPPS
the intention that those actions not take     not Start Procedure
place in this scenario.
Not saying that's wrong, just want to be      Reject - consistant
clear. If the choice is to show the same      with Radiology
id, either we would need to do messy          implementation of
stuff to get the first modality update (not   Patient Update
a great option) or tell the DSS not to
update the worklist, then all equipment
shows the temporary name.

Consider and update diagram and text.         Reject - diagrams
                                              are drawn to
                                              emphasize the use

Add to the Image Manager label at the         Accept change
top of each flow diagram "/PPS                label not diagrams

                                              Reject - normal
I believe that we need to look in more      Accept - create
detail at a Procedure Cancelled use case new C8
at least in Cath, possibly in Echo also. It
is very important to the workflow of the
department to retain information about
why/by whom/when it was cancelled so
that the flow manager is not incessantly
asked "where is patient so-and-so?".



Cath workflow for procedures not           Reject - Note on
ordered counts on the DSS to schedule timing was added
procedure steps in response to the first
MPPS message from a modality. Then,
you have to wait an undefined time for
the DSS to perform this. You have
similar problems for the case when the
patient is registered and
unregistered.Why not have the DSS
schedule one patient with an internal
patient ID for each cath room. This is the
waiting list patient that you process when
you don't have time to register/order
anything. This means that all modalities
in the room get the same Study Instance
UID. Even if the patient is registered and
there is no order information, you can
still process the "dummy" patient. You
will just have the manual step of
reconciling this patient with the
registered patient. This is not a big loss
as there are lots of manuals steps here,
anyway. Even if the patient is registered
and there is no order information, you
can still process the "dummy" patient.
You will just have the manual step of
reconciling this patient with the
registered patient. This is not a big loss
as there are lots of manuals steps here,
Case C7 has the department changing
rooms because of equipment
malfunction or when the diagnostic case
turns into an interventional case. The
specification says that someone will have
each piece of equipment in the room
(possibly malfunctioning) send a
discontinued message to the DSS. What
person in the room is going to do this.
From the malfunction issue and the
human workflow issue (will the last
person in the room toggle all the
equipment), this does not make sense.

To top