Import Reconciliation Workflow Profile

Import Reconciliation Workflow Profile Peter Mildenberger University Hospital Mainz DRG, ESR, DSC Marco Eichelberg OFFIS IHE – D Technical Manager Credits for many slides to: Cynthia A. Levy, Cedara Software IHE Technical Committee

Import Reconciliation WorkflowClinical Background • Documentation and Imaging digital (HIS/RIS/PACS) • Transfer of informations with film, CD, … • Availability of these informations at different points, like OP, ICU, ED, Radiology… • Many Films and CDs each day in all institutions • Uncoordinated workflow • Time consuming if physicians handle the media themselves

Import Reconciliation WorkflowProblem Issues • Physical Limitations • Security/Administrative: no CD drive in medical workstations • Logistical Limitations • Portable Data may include different user interfaces in viewers, some viewers don’t work • The clinician’s need to archive images temporary or permanent can’t be fulfilled • Images not available in Radiology PACS for comparison or second-opinion consult • Data Limitations • Patient not registered in the HIS • Patient not registered in the RIS

Patient Data Import Reconciliation WorkflowUse Case – External Acquisition/Read Portable Data Creator Radiology Enterprise B Radiology Site B PDI Disk 2. Radiology Site B creates portable media with patient images and/or Reports 1. Provider A orders External Radiology Procedure Radiology Enterprise A PACS A 3. Portable Media is sent to Reading Site A via CD. Patient Data is imported and read. 4. Study Results sent to Provider Provider A Radiologist

Patient Data Import Reconciliation WorkflowUse Case – Patient Referral/Transfer Radiology Enterprise A Portable Data Creator 1. Request for Patient’s case data to be transferred from Enterprise A to B. 2.Relevant Data (including film) is collected and Enterprise A creates portable media with patient’s radiology information. Radiology Enterprise B PACS B 4. Patient Data is now associated with B’s electronic health record system. 3.Data is transported to Site B via CD. Patient Demographics are reconciled and data is imported into archive.

Import Reconciliation WorkflowValue proposition • Reading and Care Planning Efficiency: easy, dispersed, in context, access to patient’s data with the familiar user interface by all physicians in the healthcare enterprise. • Reduced Cost:no need for training to use new viewers. • Quality/Safety:patient and image identifiers are available and consistent • Handling Efficiency:reduced handling effort in the patient’s data for importing process.

Import Reconciliation WorkflowScope • Import Reconciliation Workflow (IRWF) piggy-backs on Scheduled Workflow (SWF) • Import of Evidence Objects regardless of transport mechanism • Hardcopy Import (e.g. Films, Documents) • Existing Evidence Objects (e.g. CDs, Network) • Improved Demographic Integrity • Enterprise Patient/Order Information is used to identify the Evidence Objects • Original Patient Demographics are preserved within resultant Evidence Objects

Import Reconciliation WorkflowRequirements • Patient must be registered in the HIS • Patient Demographics from the Enterprise must be used to reconcile imported data • Import may be a Scheduled Order • Order information may be used to schedule the import • Order information may be used to reconcile imported data • Import may be Unscheduled

Import Reconciliation WorkflowOut of Scope UnregisteredPatient This scenario requires proper Patient Registration occur in all of the relevant Systems – HIS, RIS, PACS…

Import Reconciliation WorkflowActors/Groupings • IRWF introduces one new Actor - Importer • The Importer is transport independent, and may need to be grouped: • Portable Media Importer may be grouped with the Importer to complete the import of Evidence Objects from a PDI CD • No grouping is necessary to import Films using a Digitizer.

Import Reconciliation WorkflowOptions – and Not • The Importer must implement at least one of the following options • Scheduled Import • Unscheduled Import • Additionally, theImporter may support • Billing and Material Management • But • Import PPS messages (esp. Exception Management) are required in IRWF

Import Reconciliation Workflow Scheduled Import Option

Import Reconciliation WorkflowScheduled Import • Scheduled Import Option supports scheduling of the import. The DICOMModality Worklist provides information to the Importer about: • Enterprise Patient Demographics • Critical Attributes such as the Patient Name, Patient ID, Patient Birth Date and Patient Sex • Other Patient Ids should be a merge of the Enterprise and Imported Object • Enterprise Order Information • Critical Attributes such as the Accession Number

Import Reconciliation Workflow Transaction used for Scheduled Import • RAD-5 Query Modality Worklist provides Patient Demographics and Order information for Scheduled Import and has been enhanced to include • Scheduled Procedure Step Description may include instructions on what should be imported • Scheduled Procedure Sequence may include instructions on the subsequent use of the instances

Import Reconciliation WorkflowScheduled Import Dependencies • IRWF depends on Scheduled Workflow • Required Actors for Scheduled Import are: • Department Scheduler System/Order Filler • Image Manager/Image Archive • Performed Procedure Step Manager • Importer

Import Reconciliation WorkflowScheduled Import Transaction Diagram

Import Reconciliation WorkflowScheduled Import Workflow Diagram

Import Reconciliation Workflow Unscheduled Import Option

Import Reconciliation WorkflowUnscheduled Import • Unscheduled Import Option supports ad hoc importing. An HL7 Patient Demographics Supplier provided to the Importer about Patient Demographics: • Critical Attributes such as the Patient Name (PID:5), Patient ID (PID:3), Patient Birth Date (PID:7) and Patient Sex (PID:8) • Other Patient Ids (PID:4) should be a merge of the Enterprise and Imported Object • ITI-21 Patient Demographic Query provides Patient Demographics for Unscheduled Import

Import Reconciliation WorkflowUnscheduled Import Dependencies • IRWF depends on Scheduled Workflow • IRWF depends on IT Infrastructure Patient Demographics Query for Unscheduled Import • Required Actors for Unscheduled Import are: • Patient Demographics Supplier • Image Manager/Image Archive • Performed Procedure Step Manager • Importer

Import Reconciliation WorkflowUnscheduled Import Transaction Diagram

Import Reconciliation WorkflowUnscheduled Import Workflow Diagram

Import Reconciliation Workflow With IRWF, Data Reconciliation is done as part of the Process

Import Reconciliation Workflow Import Critical Attributes • Critical Patient Demographics and Order Information Attributes come from the Enterprise • Critical Study attributes must be maintained from the Imported Objects including: • Study Instance UID (when valid) • Referenced Study Sequence • Scheduled Protocol Code Sequence

Import Reconciliation Workflow Import Attribute Difference • The actual mapping of attributes into the Resultant IODs and the MPPS depends upon the scenario: • Digitized Evidence Objects such as Films will need to be provided Study Instance UIDs and may not contain Original Patient Demographics (unless manually provided) • Digital Evidence Objects imported using Scheduled import may contain difference in the Resultant IODs versus the MPPS • And more… See RAD-TF:2 Appendix A for all Attribute Mapping

Import Reconciliation WorkflowOriginal Import Attributes • All Attributes modified during the Import shall be maintained using Original Attribute Sequence • A new Original Attribute Sequence is added every time DICOM objects are imported. • Original attributes from digitized hardcopy may be manually entered.

Import Reconciliation WorkflowContributing Equipment Attributes • The Contributing Equipment Sequence is used to maintain information about the Importing Equipment. • Type of Equipment used to perform the import • Institution performing the import …

Import Reconciliation WorkflowCommon IRWF Transactions • The following transactions are required to complete the import: • RAD-59 Import Procedure Step In Progress is used to indicate that a Import is in-progress • RAD-60 Import Procedure Step Completed is used to indicate that a Import has been completed • RAD-61 Imported Objects Stored is used to store the Imported Evidence Objects • RAD-10 Storage Commitment ensures Imported Objects are stored

Import Reconciliation WorkflowCommon IRWF Transactions

Import Reconciliation Workflow Profile