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Master Cath Comments_4


									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 specified.

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” to
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                Schedule:
                          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 patient.
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 Procedure").
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 missed.
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 required.
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 unclear

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,
3.1-1                           why 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
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
3.1-1                              say 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     TDO          grammar   Note - the differences between the
3.3-1                              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
3.4-1                            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
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
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 exam.
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 procedure.
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
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 means.

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

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 thought.
tsippel   need a Procedure Cancelled Use

GE-HS     Table 3.2-1 should be "Cardiac Cath
GE-HS     Table 4.2-1 should be "Echo
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 approach.
General   Siemens     Medium Inconsistent    content in the the
                             chapters "Significiant Transactions".
                             They contain sometimes transaction
                             and some time general information.
page     22 Siemens   Medium Many of these transaction diagrams
(figure 3.1-                 have image manager and image
1)                           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.
3.2-1, 4.2- Siemens     High    Please      Clarify    the    ambiguity
1                               (optionality column in tables 3.2-1, 4.2-
                                1). Options cannot be required, then
                                they are no longer options

3.3       Siemens        Low  Section title "Scheduled process flow"
                              and figure legends of figures 3.3-1, -2
                              seem not fully appropriate.
p.26      Siemens      Medium Application functionality described -
                              these            implementation-specific
                              statements may distract from the
                              important       transaction    aspects:
                              1) "Start Procedure" bullet: the DSS's
                              optional function to start the Cath
                              procedure      seems      do   describe
                              application functionality. What is the
                              transaction principle behind - this is
                              unclear. Why should the DSS have
                              the ability to set a SPS on arrived? In
                              DICOM there are several "arrive"
                              states like for Scheduled Procedure
                              Step Status, Study Status ID and
                              Study Arrival Date. Which will be set
                              with "arrived": the worklist arrived at
                              the modality, the patient arrived at the
                              department         or       modality?
                              2) "Select Patient" bullet: "a modality
                              may optimize" - this is internal
                              behavior of an actor which is out of
                              scope                of             IHE.
                              2) "Query MWL" bullet (p.27): this
                              seems to be an implementation-
                              specific statement, which gives the
                              impression of required behavior.
fig. 3.3-2 Siemens    Low     Acquisition Modalitites 1..n: make
(and                          clear that n>1 acqu. Mod. Can occur
3.4       Siemens     High  The basic assumption behind alll the
                            6 defined use cases is that each of
                            the partcipating modlaity in the
                            cathlab performs separate individual
                            worklist query to DSS/OF for the
                            respective scheuled procedures. But
                            in a integrated recording & imaging
                            system lab , one of the integrated
                            modality will acts as the interface to
                            the external world such that it will
                            make the MWL and also will send the
                            PPS info back. at the same time
                            images are archived by both the
                            integrated modalities . for e.g HEMO
                            system and an imaging system acting
                            as one integrated modality with
                            HEMO interacting with the external
                            world.In this scenario HEMO system
                            initiates the MWL , updates the PPS
                            info and archives only the waveform
                            objects it creates . the images are
                            direclty archived by the imaging
3.4       Siemens    Medium There are cases where only a subset
                            of images acquired (dut to some
                            artifacts like motion error or the
                            patient moved during the exam) are
                            archived , but the image manager
                            expects all the acqired images based
                            on the information received from PPS
                            manager. So theer shall be a
                            mechnism to update the image
                            manager with the correct number of
                            images that are archived.
3.4       Siemens    Medium Section 3.4 is difficult to understand
                            because the use cases are similar
                            and                overlapping.
                            The events/transactions of Acquisition
                            Modality n are not completely shown
                            in most diagrams.

3.4-4 p.34 Siemens   Medium Unscheduled      Performed Procedure
                              Step is mentioned, references to RAD
                              TF are missing
page     37 Siemens    Low     I'd prefer to have a reminder in the
(figure 3.4-                   legend of the figure as to what Case is
5)                             being displayed. In this figure, simply
                               say "Figure 3.4-5. C-5. Patient not
3.4 -4, 5, Siemens     High    Patient Update functionality at the
6Case                          modality , for the possibilty of the
:C4, C5 &                      creation of an exchange media with
C6.                            corrected data. Same is true for
                               printing from the modality with .

Fig. 3.4-5 Siemens     High  During Procedure Patient data is also
                             in Modalities and needs to be updated
                             so that any subsequent data being
                             sent to the image manager goes with
                             the correct data.
3.4.6     Siemens            Different patient demographic data are
                             available on the different modalities
                             due     to   patient   update    during
                             procedure.How schould the user
                             handle them in case of burn on
                             exchange media or print outs
3.4-7,  Siemens       Medium Case C7 relies on the possibility that
Page 39                      the first modalities can set the MPPS
Case C7                      status to discontinued. That is not the
                             case during equipment failure.

3.4.7     Siemens     Medium The procedure Cancelled scenario not
                             defined in detail in any of use cases.

3.4.7     Siemens      Low     The equipment failure example does
                               not seem to be a good one, and
                               seems superfluos after the "change to
                               intervention" example.
Proposed Resolution                        Propose as      Final Resolution if Accepted (to be filled in
                                           Accepted/       by Comment Editor)
                                           Rejected (to be
                                           filled in by
                                           Comment Editor)

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

Should the workflow be presented with      Reject- Discuss at
a PIR requirements overlay to keep         Rad TC 7/12/04
things consistent. The requirements of     No change needed
PIR appear to be consistent. There are     to Cardiology TF
just 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 -
discuss portions of Scheduled              elaborate better in
Workflow which are required for Cath       sec 3.2 (same
Workflow, or add verbiage into the         change for Echo
section and rename the section and the     4.2)
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
importance of their support.                cardiology

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

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
MPPS with the real parameters. These        as 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 maintained.

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               Reject -
support all of the DICOM SOP Classes        conformance to
required to support the Cardiology          Cath option is
Workflow. It is expected that this be       required
documented by a reference in the IHE
Integration Statement (Appendix D of
RAD TF Vol 1).
Suggestion that the MPPS In-Progress      Accept - but text
and Complete section be put so that       improved in regard
the 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 Card vol 1
of 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       Accept - change
way for all of the participating          patient and
modalities to coordinate and to share     procedure
specific 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 Start/
means to indicate that the current Stop Improved in
procedure is "complete" wrt the 3.3 rewording
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 Same start
Framework or propogate it to other procedure
systems (only if it is needed by another discussion -
system).                                 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          Reject wording is
process control workflow are shown in      the same as RAD
this section. Then specifically state      TF 4.4.1; There is
that the PPS is not shown because it is    no critical
assumed that it is grouped. Grouping       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 devices?

Add Patient Updated RAD 12 to the          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   text 3.3 clinical
the effect of "Today Case C3 and Case context
C5 are by far the most common. It is
the intent of this Profile to move
towards the Cases C1 and C2." or
something more eloquent.
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      in vol 2 sec 4.1.1
like 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
a case. If necessary expand the PIR      to 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 RAD

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        Accept - add in
with what information goes into the      tables
IODS and the MPPS.
I would like a discussion of scheduling Reject - no
the procedures to take place in the additional modality
case where the patient may get moved support is needed.
to another room.

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

                                        Agreed. Quick fix.

                                        Accept - need
                                        more words for
                                        end procedure.
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
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 time and AE title
the worklist, possibly with an assigned for MWL
time 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 Accept - need
must be updated; where the updated elaboration
values 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
model the other as the manual or non- procedure
modality method to do the same thing. happens
And make sure the above issues are significantly
still addressed.                        sooner than
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
place in this scenario.                   Procedure
Not saying that's wrong, just want to be Reject - consistant
clear. If the choice is to show the with Radiology
same id, either we would need to do implementation of
messy stuff to get the first modality Patient Update
update (not 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 case.

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        new C8
case 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


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, anyway.
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.


                                           Reject - Required
                                           to be grouped by
Include required options in Table 3.2-1. Accept - Duplicate
If "required optionalities" are always
required, then this is a real required
transaction part, which should occur in
table 3.1-1, marked "R", perhaps having
an explaining note as well. In the
corresponding      vol.2/3   transaction
chapter, the corresponding section
should     clearly   state   that    this
transaction part is only required for the
CARD TF. Finally, the table 3.2-1
column        can       be      removed.
This principle can be used for the Echo
workflow as well.
Perhaps improve to "Cath process Accept - fixed

Clarification                     Needed: Accept - will clarify
1) explain the transaction principle in TF
2) remove this internal behaviour
3) remove this statement completely,
as there are different query options

rename      the    diagram    column Accept - will add
"Acquisition Modality" to "Acquisition in clarification
Modality 1"
Clearly Understand the user need & Reject - IHE works
acceptance to the "single modality to implement
worklist query" model where each multivendor
participating modality in a Cathlab integration.
workflow makes separate independent
Modality worklist query .

Automatic verification of study via Reject - no
MPPS       (synchronization   between proposed solution
images sent from the modality and in RAD - propose
images received in PACS).· The fact CP to Radiology if
that images that were acquired will not desired
be sent to PACS is not yet considered
in IHE RAD technical framework and
therefore there exists currently no
proposed solution for that particular

Shorten and simplify this section. Avoid Reject - editors
repetitions. Make clear the critical have reviewed and
differences between the use cases. It made some
seems sufficient to have less text while modifications.
keeping the diagrams in use cases that
are based on other use cases. Patient
reconciliation does not seem necessary
to be repeated in case 2 and 3
(reference        should        suffice).
Explain what is shown for Acquistion
Modality n (i.e. explain the incomplete

                                       Accept -
                                       references are
                                       added to top of 3.4
                                       Accept - done

Make a decision on the fact that Rejected - by IHE,
without the Patient Update functionality expected to be
at the modality , the Patient data at the done from Image
first modality is not correct and so Manager
alowed to exist without propr updation.

Add Update Patient in Modality         Rejected - by IHE,
                                       expected to be
                                       done from Image

                                       Rejected - by IHE,
                                       expected to be
                                       done from Image

Make clear note that equipment failure Accept - done
will result in no "Reassign Procedure"
ath the DSS/OF. The modalities in the
new room have to work with the original
Scheduled Procedure Step in this case.

                                       Accept - added
                                       case 8

remove this example                    Reject - Xray
                                       tubes fail during

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