SWF Options/Charge Posting

1. SWF Options/Charge Posting Andrei Leontiev Dynamic Imaging IHE Radiology Planning Committee

2. Multiple options Scheduled Workflow Profile allow certain degree of workflow “tune-up” Managing Workflow: Patient-based or Broad Worklist Queries, Assisted Protocol Setting, Exception Management, Billing and Material Management Notifications of Performed Work Status or Availability of Results: Images, Other Evidence documents, Appointments Scheduled Workflow Options IHE Interoperability Workshop

3. Modality Options in SWFTransaction Diagram IHE Interoperability Workshop

4. Gives the Department System Scheduler an option to directly control protocol settings on the Modality. Reduces variance on how procedures are performed Centralizes configuration effort Assisted Protocol OptionValue Proposition IHE Interoperability Workshop

5. Actors Affected Modality Order Filler/DSS Image Manager/Archive Report Manager Transactions Affected PPS In-Progress Standards Used DICOM (Modality Worklist and MPPS) Assisted Protocol OptionDefinition IHE Interoperability Workshop

6. Mechanism Order Filler/DSS passes Scheduled Protocol Codes to the Acquisition Modality inside the Modality Worklist Item (DICOM) Modality configuration is set accordingly either automatically or manually accepted/modified by operator Modality populates Performed Protocol Code information in MPPS The Protocol Code tables in all actors have to be synchronized Assisted Protocol OptionMechanism IHE Interoperability Workshop

7. PPS Exception Management OptionValue Proposition • Provides better feedback on discontinued studies • Handles selection of wrong worklist item IHE Interoperability Workshop

8. Actors Affected Modality Order Filler/DSS Image Manager/Archive Report Manager Transactions Affected PPS Completed Standards Used DICOM (MPPS) PPS Exception Management Option Definition IHE Interoperability Workshop

9. Mechanism Provision of Discontinue Reason Code in PPS Completed transaction: Doctor cancelled procedure Equipment failure Incorrect procedure ordered Patient allergic to media/contrast Patient died Patient refused to continue procedure Patient taken for treatment or surgery Patient did not arrive Patient pregnant Change of procedure for correct charging Duplicate order Nursing unit cancel Incorrect side ordered Discontinued for unspecified reason Incorrect worklist entry selected Patient condition prevented continuing Exception Management OptionMechanism IHE Interoperability Workshop

10. Provides a mechanism for the Order Placer to keep track of appointments scheduled for a patient within Radiology Department Includes notifications of scheduling, re-scheduling and cancellation events Helps synchronization of scheduling processes between enterprise and radiology Appointment NotificationValue Proposition IHE Interoperability Workshop

11. Appointment Notification Option Definition • Actors Affected • Order Filler/DSS • Order Placer • Standards Used • HL7 v. 2.4 SIU messages • Transactions affected • Appointment Notification IHE Interoperability Workshop

12. Mechanism One appointment corresponds to one or more Scheduled Procedure Steps Department System Scheduler/Order Filler generates Appointment Notification messages and sends them to the corresponding Order Placer actor. One message may convey multiple appointments corresponding to a single order Order Placer receives Appointment Notification messages and internally processes them. Appointment Notification OptionMechanism IHE Interoperability Workshop

13. Specifies common information for one or more appointments associated with single order Appointment timing is defined on the per Scheduled Procedure Step level One message can have multiple appointments (procedure steps) No patient identification information is required, thus Order Numbers are required Specifies Procedure Code and Description Not all steps of the procedure may be included Date/Time of an appointment is expected to be in UTC If local, UTC offset is required Appointment Notification OptionDetails IHE Interoperability Workshop

14. Departmental Appointment Notification Option does not allow Order Placer to request re-scheduling – it only can do it by cancel and re-order Transaction does not require AIL segment – thus notifications on re-scheduling of the service from one location to another may not be sent This option does not address needs of enterprise-wide scheduling What is not in the option IHE Interoperability Workshop

15. Enhances mechanism that allows to obtain information about availability of newly-acquired images and other evidence objects, for further use in workflow. Avoids “performance penalty” of Instance Availability query mechanism that forces “managers” to poll Image Manager/Archive for availability of evidence objects. Provides this information to all workflow management actors. Instance Availability NotificationValue Proposition IHE Interoperability Workshop

16. Instance Availability Notification Option Definition • Actors Affected • Image Manager/Archive • Order Filler/DSS • Post-Processing Manager • Report Manager • Standards Used • DICOM (Instance Availability Notification SOP Class; Supplement 93 Final Text) • Transactions affected • Instance Availability Notification IHE Interoperability Workshop

17. Mechanism Image Manager/Image Archive generates an Instance Availability Notification message and send it to the DSS/Order Filler and optionally to other workflow managing actors (Post-Processing Manager, Report Manager). DSS/Order Filler, Post-Processing Manager, Report Manager receive an Instance Availability Notification message and internally process it.. Instance Availability Notification OptionMechanism IHE Interoperability Workshop

18. “ONLINE” the instances are immediately available from the Retrieve AE Title, and if a C-MOVE were to be requested, it would succeed in a reasonably short time “NEARLINE” the instances need to be retrieved from relatively slow media such as optical disk or tape, and if a C-MOVE were to be requested from the Retrieve AE Title, it would succeed, but may take a considerable time Instance Availability Values IHE Interoperability Workshop

19. “OFFLINE” manual intervention is needed before the instances may be retrieved, and if a C-MOVE were to be requested from the Retrieve AE Title, it would fail (e.g., by timeout) without such manual intervention. “UNAVAILABLE” the instances cannot be retrieved from the Retrieve AE Title, and if a C-MOVE were to be requested, it would fail. Note that SOP Instances that are unavailable from this AE may be available from other AEs, or may have an alternate representation that is available from this AE. Instance Availability Values IHE Interoperability Workshop

20. Image Manager shall send only one IAN message for each MPPS referencing at least one evidence object. Image Manager shall sent IAN when it received ALL instances referenced in MPPS Timing of a message can vary significantly depending on timing of MPPS and object storage No message may be sent if complete object set never arrives No message may be sent if objects arrive without corresponding MPPS Even when objects are included in IAN, the retrieval request may fail due to errors Instance Availability Notification OptionDetails IHE Interoperability Workshop

21. Actors receiving IAN message are expected to use its content for workflow management. Examples of internal actions: The Department System Scheduler/Order Filler may update the procedure status internally, indicating that images for the procedure have been stored. The Post-Processing Manager may add or re-arrange items to a corresponding worklist. The Report Manager may add items to a corresponding worklist. Instance Availability Notification OptionDetails IHE Interoperability Workshop

22. This option only addresses the use case when MPPS referencing evidence objects has been received by Image Manager. Image Manager generates Instance Availability Notification upon receiving of all objects referenced in particular MPPS. Cross-referencing of MPPS in IAN may compensate for MPPS missed by OF What is not in the option IHE Interoperability Workshop

23. The Department System Scheduler/Order Filler provides the procedure data that is used by the Charge Processor to generate claims and submit them to payors. Fees associated with the procedures may be defined by the Department System Scheduler/Order Filler or by the Charge Processor. Claim/Bill creation from charges and communication with payors is out of scope of the profile Charge PostingAbstract / Scope IHE Interoperability Workshop

24. Standardizes data exchange of charges from radiology to the financial systems Reduces the need of the billing system to have knowledge of the radiology internals. Charge Processor receives more complete, timely and accurate data. Charge PostingValue Proposition IHE Interoperability Workshop

25. Charge PostingTransaction Diagram IHE Interoperability Workshop

26. Health Level Seven, Version 2.3.1: Chapter 6 - Financial Management DFT^P03 message DICOM 2003 PS 3.4 Modality Performed Procedure Step SOP Class Billing and Materials Management module – allows Modality specify billing information, including material consumption (contrast, film, etc.) Charge PostingStandards Used IHE Interoperability Workshop

27. IHE Web site: http://www.ihe.net http://www.himss.org/IHE http://www.rsna.org/IHE http://www.acc.org/quality/ihe.htm Technical Frameworks Technical Framework Supplements – Trial Implementation Non-Technical Brochures : Calls for Participation IHE Fact Sheet and FAQ IHE Integration Profiles: Guidelines for Buyers IHE Connect-a-thon Results Vendor Products Integration Statements More information…. Questions? IHE Interoperability Workshop