Sheet1 - IHE

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					#    Specific Name of       Level of Comment
     Section # Person       Severity
               Submitting   (high-
               (optional)   serious
                            or low -
12   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.

13   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.

37   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    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?

14   3.2      CAL           medium     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
15   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?
17   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

18   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.
19   3.3   CAL   medium   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”

20   3.3   CAL   medium   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”.

21   3.3   CAL   medium   Paragraph labeled Storage
                          Commitment:The requirement stated in
                          this paragraph is no different from the
                          RAD TF Storage Commitment.
33   3.3        Camtronics              In the bullet point starting with “Modality
                                        Procedure Step In Progress…”: A
                                        “modality ID” is referred to.

39   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.”
4    3.4        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
5    3.4        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.

23   3.4        CAL            medium   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.

29   3.1 –       Camtronics             IHE-Rad SWF shows Transactions 11
     Figure 3.1-                        and 42 between the DSS/OF and the
     1                                  IM/IA.
30   3.1 –       Camtronics             IHE-Rad SWF has Transactions 11
     Table 3.1-                         and 42 in the DSS/OF actor and
     1                                  Transactions 11 and 42 in the IM/IA
32   3.1 –      Camtronics              IHE-Rad PIR has Transaction 12 in the
     Table 3.1-                         IM/IA actor.
1    3.1-1      Teri Sippel    low      transactions in figures are lower case,
                                        but transactions in text are upper case
                                        (eg, CARD-1)
2    3.1-1 table Teri Sippel   high     Image Manager/Archive is missing a
     3.1-1                              transaction

16   3.3 Fig 3.3-CAL           low      Differences between Rad and Cath are
     1                                  shown in color. Not everyone has
                                        access to color printers
40   3.3 p26     GE_CP         mid      The definition of start procedure is very

41   3.3 p27     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 ?
42   3.3 p27     GE_CP                  In Query Mopdality Worklist bullet, why
                                        these wishy washy terms of may,
                                        would, Is there one and only one in that
                                        case or not ?
43   3.3 p27     GE_CP                  In the Storage commitment bullet, why
                                        use only “must” and not “shall” in
                                        relationship to the support of mobile
6    3.4 table   Teri Sippel   med      Table of use cases is misleading…
     3.4-1                              clinical folks will think we are dreaming.

7    3.4 table   Teri Sippel   med      what does the Note apply to?
24   3.4.2       CAL           medium   IHE Context: Case2 is currently
                                        supported by RAD Scheduled
8    3.4.3       Teri Sippel   high     2nd para in IHE Context: should it say
                                        something about using a 'generic'
                                        procedure code (I know it is covered in
                                        Vol 2).
25   3.4.3       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?
34   3.4.3       Camtronics             In the bullet point starting with “Using
                                        the information from the MPPS
                                        transaction…”: A “modality station
                                        name” is referred to.
26   3.4.4       CAL           high     C4 – Emergency Patient with
                                        Procedure Ordered The workflow
                                        defined here is normal except for the
                                        fact that PIR is required.
9    3.4.5       Teri Sippel    high     after fig 3.4-5 bullet 4 - it is kind of
                                         wimpy. Sounds like a recommendation,
                                         not a requiremetn.

27   3.4.6       CAL            medium   C6 – Patient Update during Procedure.
                                         This is covered by PIR

10   3.4.7       Teri Sippel    low      clinical scenario' should be 'clinical
11   3.4.7       Teri Sippel    high     assumption of what is in a Requested
                                         Procedure is too naïve.

28   3.4.7       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)
36   3.1-1 Fig   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.
36   3.4-5 Fig   Rick Bennett   low      I'd prefer to have a reminder in the
                                         legend of the figure as to what Case is
                                         being displayed. In this figure, simply
                                         say "Figure 3.4-5. C-5. Patient not
35   General     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
38   3.2.1       GE_CP          low      This table is confusing because it
     Table                               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.
44   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.
3B 3.4        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
4B 3.4        Teri Sippel   low       case # does not appear in Figure titles
                                      as it does in Echo use cases
1    3.3      TDO           H         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

1    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    3.4.3    TDO           grammar   Note - the differences between the
                                      radio and cardio TF should be bulleted
                                      for effect
2    3.4.3   / TDO          grammar   the explanation of the working of the
     3.4.5                            MPs in progress is simikar to the
                                      discussion in 3.3 above
2   3.4.3,    agfa-sg   medium   When the Order Filler auto-creates the
    Page 33                      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   3.4.4     agfa-sg   medium   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 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
4   3.4.5     agfa-sg   medium   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
5   3.4.7   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.

6   3.4.7   agfa-sg   medium   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.

            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"
3.3   smm   Under Create Order: The Order Placer
            is the enterprise repository for all
            patient orders.
      smm   Counting on DSS to schedule
            procedures is dangerous

      smm   Cath workflow, room change
14   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).

15   3.4.2   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
16   3.4.5   agfa-pas   medium   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.

4    I-3.3   KOD        H        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.

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

7    I-3.3   KOD        L        Query Modality Worklist text implies
                                 that there is never more than one
                                 procedure step scheduled for a patient.

8    I-3.3   KOD        L        Fig    3.3-2   doesn't  show         the
                                 corresponding End Procedure.

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

11   I-3.3     KOD   H   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
12   I-3.3     KOD   H   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

13   I-3.3     KOD   L   Update Status text is more detailed
                         than the Start Procedure text.

14   I-3.3     KOD   H   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?

15   I-3.4.1   KOD   L   Fig 3.4-1 needs a break in the DSS
                         Boxes after the Start Procedure and
                         Update Procedure actions
16   I-3.4.3   KOD   L   Fig 3.4-3 doesn't have a Start

17   I-3.4.6   KOD   H   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
18   I-3.4-7   KOD     H   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.

     App A     GE-HS       We especially need clarification
                           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
     App A     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
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        Discuss at Rad TC
work can’t be broken down so there is a    7/12/04 No change
1-1 correspondence with the Number of      needed to
Requested Procedures.                      Cardiology TF

Should the workflow be presented with a    Discuss at Rad TC
PIR requirements overlay to keep things    7/12/04 No change
consistent. The requirements of PIR        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   Reject - however
discuss portions of Scheduled Workflow     workflow is
which are required for Cath Workflow, or   different from Rad -
add verbiage into the section and          Intro should clarify
rename the section and the table.          this. TBD
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.

The following is a suggestion which          Accept Change
would need to have all the elements          name of
worked through: Use the Scheduled            transaction
Procedure as a “seed”, but then
discontinue and create an unscheduled
MPPS with the real parameters. These
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 - there will
for Broad Query Support.                    be explanations
Recommendation would be acceptable.

The Image Manger/Archive must support Reject -
all of the DICOM SOP Classes required conformance is
to support the Cardiology Workflow. It is required
expected that this be documented by a
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       Performe+G33d
something else?                             Station AE

Replace by: “so there needs to be a way Accept
for all of the participating modalities to
coordinate and to share specific

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.

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

Add Patient Updated RAD 12 to the table Accept - change

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.
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

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

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
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.'

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.

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

                                            Agreed. Quick fix.

                                            Accept - need
                                            more words for end

Break this in two tables.                   Reject
Change title of 3.3 to Cath Scheduled      Accept
Process Flow. And remove Case C1 in
3.4 which is almost entire duplication.

make optional or required.                 Accepted - text

add use case # to figure titles            Accept

WE should advise that DSS provide a Duplicate
means to indicate that the current Start/Stop
procedure is "complete" wrt the
acquisition modalities in that room. This
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

bullet the two differences discussed.      Accept

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.

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

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
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.

Add to the Image Manager label at the       Accept change
top of each flow diagram "/PPS              lable 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?".


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

Cath workflow for procedures not           Reject -
ordered counts on the DSS to schedule
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.
Either remove the "optionality" column       Accept - elaborate
from the table or clearly explain what it    first paragraph of
means to have an "option" that's             3.2

Reference the SWF 'order replacement         Accept - with
by the DSS/OF' case and PIR case #2.         reference

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

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

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