PowerPoint Presentation - IHE North American Connectathon 2012

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					Scheduled Workflow
        and

Patient Information
  Reconciliation
                              Scope

• Genesis 1: In the beginning, …

    •     [ or better yet ]



• Genesis 11: Tower of Babel
  – “and there confound their language,
    that they may not understand one
    another's speech. “
                       Scope



• Backbone of IHE Radiology
• Integrates Registration, Scheduling,
  Acquisition Workflow and Image
  Content
• Bridges HL7 and DICOM Spaces
                                            Use Case

                                                                                report
                                                                           report
  Registration                                               Report
                                   report
                                                            Repository

HIS patient                                                                  Diagnostic         Film
     information                                                             Workstation      Lightbox
                                                                                     images
                                                                  PACS              retrieved



     Orders Placed
                                               procedure
                                               scheduled                                       Film
                                                                              Image Manager
                                           Prefetch any relevant                              Folder
examination orders                                                               & Archive
                                           prior studies
                                     modality             Acquisition
                                                                      images
                                      worklist              Modality
                   Orders Filled                                       stored
       RIS                                                             acquisition
                                                                       completed
                                   acquisition                                                  Film
                                   in-progress
                                    completed                                images
                                                                             printed
                                                    Modality
                    Value Proposition


• Preserve Order Continuity
  – “Close the Loop”
  – maintain accession number, avoid
    confusion with Filler #, Placer #, etc.
• Improve Demographic Integrity
  – Data entry errors
    • significant occurrence
    • significant consequences
  – Enter once, pass from system to system
                    Value Proposition



• Improve Workflow Efficiency
  – Use of Worklists
    • less time spent doing data entry/selection
    • enables semi-automation of setup
• Reliable Storage
  – Storage Commitment
    • fewer lost studies
    • more confidence in results
                   Value Proposition


• Improve Order Tracking
  – MPPS from Modality to RIS & PACS
    • more timely feedback
    • more precise feedback
• Reduce Integration Effort at Site
  – Get Vendors on the Same Page
  – Provide Implementation Guidance
  – Pre-test at Connectathon
                  Participant Actors

• ADT Patient Registration
• Order Placer
• Order Filler – Department System
  Scheduler
• Image Manager – Archive
• Acquisition Modality
• Image Display
• Evidence Creator
                                                                                 Order Flow



                                       ADT

Pt registration: 1                                        1: Pt registration
   Pt Update: 12 
                            2: Placer Order Management
                            3: Filler Order Management
                                                           12: Pt Update
                                                                                      HL7 Actors:
       Order Filler                                          Order Placer

                        4: Procedure Scheduled
                                                                                      • ADT/Patient
                        12: Patient Update
                                                                                        Registration
                        13: Procedure Update
                                                                                      • Order Placer
                                                                                      • DSS / Order Filler
                                     Image
                                    Manager
                                                                                      • Image Manager
                       Order Flow


• Patient Registration
  – Admit: In Patient, Out Patient, Pre-Admit
  – Cancel
• Patient Update
  – Transfer, Discharge, Outpatient-to-
    Inpatient, Inpatient-to-Outpatient
  – Update Patient Demographics
  – Merge Patient Records
  – Cancel Transfer, Cancel Discharge
                       Order Flow


• Order Management
  – New Order: Enterprise and Department
  – Cancel Order
  – Order Status Update
• Schedule Procedure
  – Schedule new Procedure for an order
  – Reschedule/Change Procedure details
                                                                             Procedure Flow


               DSS/ Order Filler


 Modality PS in Progress [6]
 Modality PS Completed [7]
                                        Procedure Scheduled [4]
                                        Image Availability Query [11]
                                        Procedure Updated [13]
                                                                                                                             DICOM Actors:
 Creator PS in Progress [20]           Performed Work Status Update [42]
 Creator PS Completed [21]             Performed Work Status Update [42]

                                                                 Evidence Creator                Image Display
                                                                                                                             • DSS / Order Filler
                                                                                                                             • PPS Manager
      Creator PS in Progress [20]
      Creator PS Completed [21]

                                                      Storage                 Creator Images
                                                                                                     Query Images [14]
                                                                                                                             • Image Manager /
 Performed                                        Commitment [10]           Stored [18]
  Procedure                                                                                          Retrieve Images [16]
Step Manager


                                                              Image           Image
                                                                                                                               Archive
                                                             Manager         Archive

                                                                                                                             • Acquisition Modality
       Modality PS in Progress [6]
       Modality PS Completed [7]
       Creator PS in Progress [20]
       Creator PS Completed [21]

                                                                                                                             • Evidence Creator
                                                 Storage                      Modality Image Stored [8]
                                                 Commitment [10] 

     Modality PS in Progress [6]
     Modality PS Completed [7]
                                                                   Acquisition
                                                                    Modality
                                                                                                                             • Image Display
     Modality Worklist Provided [5]
                                                                       Acquisition Workflow
                                                                          Management

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

     Modality PS in Progress [6]
     Modality PS Completed [7]
                                                                   Acquisition
                                                                    Modality
     Modality Worklist Provided [5]
                                                                        Image Management

               DSS/ Order Filler
                                        Procedure Scheduled [4]
 Modality PS in Progress [6]           Image Availability Query [11]
 Modality PS Completed [7]             Procedure Updated [13]
 Creator PS in Progress [20]
 Creator PS Completed [21]
                                        Performed Work Status Update [42]
                                        Performed Work Status Update [42]

                                                                 Evidence Creator                Image Display
                                                                                                                             DICOM:
      Creator PS in Progress [20]
      Creator PS Completed [21]                                                                                             • Image Storage
                                                      Storage                 Creator Images
                                                                                                     Query Images [14]
                                                                                                                             • Storage
 Performed                                        Commitment [10]           Stored [18]
  Procedure                                                                                          Retrieve Images [16]
Step Manager


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

     Modality PS in Progress [6]
     Modality PS Completed [7]
                                                                   Acquisition
                                                                    Modality
     Modality Worklist Provided [5]
                Scheduled Workflow Options

• Tune up Workflow Management
  –   Patient-based or Broad Worklist Queries,
  –   Assisted Protocol Setting,
  –   Exception Management,
  –   Billing and Material Management
• Notification of Performed Work Status or
  Availability of Results:
  – Images,
  – Other Evidence documents,
  – Appointments
          Exception Management Option



• Provides better feedback on
  discontinued studies
• Handles selection of wrong worklist
  item
            Exception Management Option
                     Mechanism

• Modality can provide Discontinued
  Reason Code to indicate WHY the
  procedure has not been completed,
  for example:
  – Equipment failure
  – Incorrect procedure ordered
  – Incorrect worklist entry selected
  – Patient condition prevented continuing
Patient Information
  Reconciliation

 Expect the Unexpected
               Patient Information
                 Reconciliation


• Extension of Scheduled Workflow
• Coordinated update of demographic
  information in workflow and content
  objects
                 Patient Information Reconciliation
                          Value Proposition

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

• ALL ER patients are pre-registered
  (“John Doe”, “Jane Doe”):
  – Case 1: Unidentified Patient registered at
    ADT and order is placed at Order Placer.
  – Case 2: Unidentified Patient registered at
    ADT and order is placed at DSS/Order
    Filler.
  – Case 3: Unidentified Patient registered at
    ADT but acquisition completed at Modality
    prior to order.
               Use Cases

• ER patients are registered with
  Departmental IDs:
  – Case 4: Unidentified Patient assigned
    temporary Departmental ID and
    scheduled at DSS/Order Filler.
  – Case 5: Image Acquisition completed
    prior to assigning temporary
    Departmental ID or Order (Patient ID
    entered at the Modality).
                                           “Emergency” - Case 3

                         Order                Department System            Image
ADT                                           Database/Scheduler/         Manager
                         Placer                                                                Modality
                                                  Order Filler
       Register J.Doe
                                                                                                     Images
       Patient                                                                                       Acquired
     Registration [1]

                                                        Modality Procedure     Modality Procedure
                                                        Step Completed [7]     Step Completed [7]



                                  Filler Order Mgmt

                                  New Order [3]
                                                        Schedule Procedure


                                                          Procedure
                                                          Scheduled [4]


Patient Reconciliation
      J.Doe -> J.Smith
      Patient                                           Patient
      Update [12]                                       Update [12]

				
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