Presentation of Grouped Procedures Integration Profile

1. Presentation of Grouped ProceduresIntegration Profile Charles Parisot GE Medical Systems IT Planning andTechnical Radiology Committees

2. Scheduled Workflow Patient Informa-tion Reconci-liation Reporting Workflow Post-Processing Workflow , Simple Image and Numeric Reports Consistent Presentation of Images Evidence Documents Key Image Notes Quick Review of Scheduled Workflow Charge Posting - Presentation of Grouped Procedures Access to Radiology Information Basic Security April 2003 Workshop

3. Patient Registration/UpdateOrder Management Worklist Modality Worklist Procedure Scheduled Store Images StorageCommitment Storage Commitment List of Images Modality Performed Procedure Step Performed Step: Status = Completed Performed CT Head Pat Name/ID, Dose, Accession #, Study UID Complete List of Images IHE Scheduled Workflow RIS PACS &Archive • A Closed Loop • Update IS Scheduling • Match Procedure with Order • Support Billing Based on MPPS • Avoid Reading incomplete Procedures April 2003 Workshop

4. IHE Workflow Concepts IHE identifies four fundamental workflow information units : Procedure Steps :The smallest unit of work in the workflow:SCHEDULED PROCEDURE STEP: ‘A unit of work to do’PERFORMED PROCEDURE STEP: ‘A unit of work done’ ORDER :A request for radiologic service REQUESTED PROCEDURE : A Unit of Reporting Work with associated codified, billable acts April 2003 Workshop

5. CLINICIANOR REFERING DOC:The Imaging Dept Customer RADIOLOGIST : In Charge of producing the Report TECHNOLOGIST(and RADIOLOGIST)In charge of acquiring images, etc. IHE Workflow is User Driven Information Unit has its Prime User ORDER:A request for imaging service (Accession Number) REQUESTED PROCEDURE : Units of work resulting in one Reportwith associated codified, billable acts(Requested Procedure ID) PROCEDURE STEP :The smallest unit of workin the workflow (modality worklist entry) April 2003 Workshop

6. DICOMModality Worklist ScheduledProcedure Step A Report One or more series of images PerformedProcedure Step P1 AcquisitionModality Normal Workflow Radiology Department ORDER A request for RadiologicService Set of Codifiable, Billable, Acts Requested Procedure 1 April 2003 Workshop

7. DICOMModality Worklist ScheduledProcedure Step A Report ScheduledProcedure Step B One or more series of images One or more series of images DICOMModality Worklist PerformedProcedure Step P1 PerformedProcedure Step P2 AcquisitionModality AcquisitionModality Multiple Modality Steps Radiology Department ORDER A request for RadiologicService Set of Codifiable, Billable, Acts Requested Procedure 1 April 2003 Workshop

8. DICOMModality Worklist ScheduledProcedure Step A Report One or more series of images One or more series of images DICOMModality Worklist AcquisitionModality PerformedProcedure Step P1 PerformedProcedure Step P2 Multiple Modality Steps (Append) Radiology Department ORDER A request for RadiologicService Set of Codifiable, Billable, Acts Requested Procedure 1 April 2003 Workshop

9. DICOMModality Worklist DICOMModality Worklist ScheduledProcedure Step A Report One or more series of images ScheduledProcedure Step B Discontinue No PerformedProcedure Step PerformedProcedure Step P1 AcquisitionModality Discontinue a Modality Step Radiology Department ORDER A request for RadiologicService Set of Codifiable, Billable, Acts Requested Procedure 1 Requested Procedure 2 April 2003 Workshop

10. Slide Provided by Gary Wendt, MD April 2003 Workshop

11. Report Report One or more series of images PerformedProcedure Step P1 AcquisitionModality Group Case2 Requested Procedures but a single Acquisition Radiology Department ORDER A request for RadiologicService Requested Procedure 1 Requested Procedure 2 April 2003 Workshop

12. DICOMModality Worklist ScheduledProcedure Step A Report ScheduledProcedure Step B Report One or more series of images PerformedProcedure Step P1 AcquisitionModality Group Case Radiology Department ORDER A request for RadiologicService Set of Codifiable, Billable, Acts Requested Procedure 1 Set of Codifiable, Billable, Acts Requested Procedure 2 April 2003 Workshop

13. Is Grouping of Procedures a common need ? • CT Chest/Abdomen/Pelvis • Neuroradiology: CT Neck & CT Chest • MR Imaging of different sections of the spine • MRI and MRA of vessels acquired together • MRI of the head and neck with specialized coils • Direct radiography (DR) in a trauma patient: AP images, then move the patient once to acquire a set of orthogonal images, and then regroup by body part • Sonographic evaluation of the kidneys and of the abdomen • CT of the pelvis with CT angiographic runoff • Angiographic studies of multiple vessels mixed with therapeutic interventions on selected segments. April 2003 Workshop

14. Why Grouping of Procedures ? • Optimize patient comfort • Optimize time of image acquisition. But, there is also the need to: • Maintain the link back to each one of the grouped procedures without breaking the acquisition apart. • Ensure that each image subset related to a requested procedure is identified and ready to be presented. This is key for quick display of new and prior studies. • In the film world, images are manually sorted. In the film-less world, images should be sorted automatically when displayed April 2003 Workshop

15. Grouping of Procedures in IHE Group Case support is required by the IHE Scheduled Workflow Integration Profile on Image Managers (PACS) and Order Fillers (RIS). Its support is optional on Modalities. April 2003 Workshop

16. Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Key ImageNotes Access toRadiologyInformation Patient Information Reconciliation Exchange flaggingsignificant images Consistentaccess to images andreports Unknown patients and unscheduled orders Simple Image andNumeric Reports Exchange simplereports with image links and, optionally, measurements Presentation ofGrouped Procedures Presentation ofGrouped Procedures Subset a single acquisition Subset a single acquisition ConsistentPresentation of Images Hardcopy and softcopy grayscale and presentation state IHE Integration Profiles April 2003 Workshop

17. Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Key ImageNotes Access toRadiologyInformation Patient Information Reconciliation Exchange flaggingsignificant images Consistentaccess to images andreports Unknown patients and unscheduled orders Simple Image andNumeric Reports Exchange simplereports with image links and, optionally, measurements ConsistentPresentation of Images Hardcopy and softcopy grayscale and presentation state IHE Integration Profiles Presentation ofGrouped Procedures Subset a single acquisition April 2003 Workshop

18. Scheduled Workflow Admit, order, schedule, acquire images, notify of completed steps Presentation ofGrouped Procedures Presentation of Subsets of a Single Acquisition Required for ConsistentPresentation of Images Softcopy grayscale and presentation state IHE Integration Profiles + April 2003 Workshop

19. Chest View Report:CHEST Report:ABDOMEN Abdomen View ScheduledProcedure Step Chest Chest View Abdomen View Operator groups 2 procedures IHE – Presentation of Grouped Procedures Requested Procedure:CHEST Requested Procedure:ABDOMEN ScheduledProcedure Step Abdo RIS / PACS MODALITY Performs a single exam April 2003 Workshop

20. Presentation of Grouped Procedures • Improves workflow, overall efficiency of care and reduces costs of providing services: • Lowers barriers to migration to digital radiology practice • Optimizes use of newer & faster acquisition devices • Improves clarity and access to Radiology results • Simplifies and facilitates billing of grouped procedures • Enhances softcopy interpretation throughput April 2003 Workshop

21. Slide Provided by Gary Wendt, MD April 2003 Workshop

22. Questions? Documents Available On the Web at: www.rsna.org/IHE April 2003 Workshop