ihe radiology workflow: adaptation to cardiology harry solomon
TRANSCRIPT
IHE Radiology Workflow:IHE Radiology Workflow:Adaptation to CardiologyAdaptation to Cardiology
Harry SolomonHarry Solomon
March, 2004 IHE Cardiology Technical Committee2
Access toRadiology
Information
Consistentaccess to
images andreports
IHE Radiology Integration ProfilesIHE Radiology Integration Profiles
Patient Information
Reconciliation
Unknown patients and unscheduled
orders
ConsistentPresentation of
Images
Hardcopy and softcopy
grayscale and presentation state
Presentation ofGrouped Procedures
Subset a single acquisition
Key ImageNotes
Exchange flaggingsignificant images
Simple Image andNumeric Reports
Exchange simplereports with image
links and, optionally,measurements
Scheduled WorkflowAdmit, order, schedule, acquire images, notify of completed steps
March, 2004 IHE Cardiology Technical Committee3
Integration Profiles to be Adapted Integration Profiles to be Adapted for Cardiology Year 1for Cardiology Year 1
Patient Information
Reconciliation
Unknown patients and unscheduled
orders
Scheduled WorkflowAdmit, order, schedule, acquire images, notify of completed steps
4 IHE Cardiology Technical CommitteeMarch, 2004
A Review of A Review of “Normal” Workflow Processes“Normal” Workflow Processes
• Topics:Topics:– HL7 Actors and Transactions in IHE HL7 Actors and Transactions in IHE – DICOM Actors and TransactionsDICOM Actors and Transactions– Normal Workflow ProcessesNormal Workflow Processes– Patient and Order Update ProcessesPatient and Order Update Processes– Patient Information ReconciliationPatient Information Reconciliation– SummarySummary
March, 2004 IHE Cardiology Technical Committee5
1: Pt registration 12: Pt Update
Pt registration: 1 Pt Update: 12 2: Placer Order Management
3: Filler Order Management
ADT
4: Procedure Scheduled 12: Patient Update 13: Procedure Update
Image Manager
Order Placer Order Filler
HL7 Actors in WorkflowHL7 Actors in Workflow
HL7 Actors:HL7 Actors:• ADT/Patient ADT/Patient
RegistrationRegistration• Order PlacerOrder Placer• DSS / Order FillerDSS / Order Filler• Image ManagerImage Manager
March, 2004 IHE Cardiology Technical Committee6
1: Pt registration 12: Pt Update
Pt registration: 1 Pt Update: 12 2: Placer Order Management
3: Filler Order Management
ADT
4: Procedure Scheduled 12: Patient Update 13: Procedure Update
Image Manager
Order Placer Order Filler
ADT ActorADT Actor
March, 2004 IHE Cardiology Technical Committee7
ADT ActorADT Actor
• 4.1 - Patient Registration transaction4.1 - Patient Registration transaction– SendSend
• Admit: A01 (In Patient), A04 (Out Patient), A05 (Pre-Admit: A01 (In Patient), A04 (Out Patient), A05 (Pre-Admission)Admission)
• Cancel: A11 (Cancel Admit), A38 (Cancel Preadmit)Cancel: A11 (Cancel Admit), A38 (Cancel Preadmit)
March, 2004 IHE Cardiology Technical Committee8
ADT Actor (cont.)ADT Actor (cont.)
• 4.12 - ADT Patient Update transaction4.12 - ADT Patient Update transaction– SendSend
• Transfer: A02 (Patient Transfer)Transfer: A02 (Patient Transfer)• Update Patient Class: A03 (Discharge), A06(Outpatient Update Patient Class: A03 (Discharge), A06(Outpatient
becomes Inpatient), A07 (Inpatient becomes Outpatient)becomes Inpatient), A07 (Inpatient becomes Outpatient)• Update Patient Information: A08 (Update)Update Patient Information: A08 (Update)• Merge Patients: A40 (Merge)Merge Patients: A40 (Merge)• Cancel: A12 (Cancel Transfer), A13 (Cancel Discharge)Cancel: A12 (Cancel Transfer), A13 (Cancel Discharge)
March, 2004 IHE Cardiology Technical Committee9
1: Pt registration 12: Pt Update
Pt registration: 1 Pt Update: 12 2: Placer Order Management
3: Filler Order Management
ADT
4: Procedure Scheduled 12: Patient Update 13: Procedure Update
Image Manager
Order Placer Order Filler
Order Placer ActorOrder Placer Actor
March, 2004 IHE Cardiology Technical Committee10
Order Placer ActorOrder Placer Actor
• 4.2 - Placer Order Management transaction4.2 - Placer Order Management transaction– SendSend
• New Order: ORM/NW (New Order)New Order: ORM/NW (New Order)• Cancel: ORM/CA (Cancel Order), ORM/DC (Discontinue)Cancel: ORM/CA (Cancel Order), ORM/DC (Discontinue)
March, 2004 IHE Cardiology Technical Committee11
Order Placer Actor (cont.)Order Placer Actor (cont.)• 4.1 - Patient Registration transaction4.1 - Patient Registration transaction
– ReceiveReceive• A01 (In Patient), A04 (Out Patient), A05 (Pre-Admission), A11 (Cancel A01 (In Patient), A04 (Out Patient), A05 (Pre-Admission), A11 (Cancel
Admit), A38 (Cancel Preadmit)Admit), A38 (Cancel Preadmit)
• 4.12 - Patient Update transaction4.12 - Patient Update transaction – ReceiveReceive
• A02 (Patient Transfer), A03 (Discharge), A06(Outpatient becomes A02 (Patient Transfer), A03 (Discharge), A06(Outpatient becomes Inpatient), A07 (Inpatient becomes Outpatient), A08 (Update), A12 Inpatient), A07 (Inpatient becomes Outpatient), A08 (Update), A12 (Cancel Transfer), A13 (Cancel Discharge), A40 (Merge)(Cancel Transfer), A13 (Cancel Discharge), A40 (Merge)
• 4.3 - Filler Order Management transaction4.3 - Filler Order Management transaction – ReceiveReceive
• ORM/SN (New Order), ORM/SC (Status Update), ORM/OC (Cancel ORM/SN (New Order), ORM/SC (Status Update), ORM/OC (Cancel Order)Order)
March, 2004 IHE Cardiology Technical Committee12
1: Pt registration 12: Pt Update
Pt registration: 1 Pt Update: 12 2: Placer Order Management
3: Filler Order Management
ADT
4: Procedure Scheduled 12: Patient Update 13: Procedure Update
Image Manager
Order Placer Order Filler
DSS / Order Filler ActorDSS / Order Filler Actor
March, 2004 IHE Cardiology Technical Committee13
Department System Department System Scheduler/Order Filler ActorScheduler/Order Filler Actor
• 4.3 - Placer Filler Management transaction4.3 - Placer Filler Management transaction– SendSend
• New Order: ORM/SN (New Order)New Order: ORM/SN (New Order)
• Order Status: ORM/SC (Status Change)Order Status: ORM/SC (Status Change)
• Cancel: ORM/OC (Cancel Order)Cancel: ORM/OC (Cancel Order)
• 4.4 - Procedure Scheduled transaction4.4 - Procedure Scheduled transaction– SendSend
• ORM (procedure scheduled)ORM (procedure scheduled)
• 4.13 - Procedure Updated transaction4.13 - Procedure Updated transaction– SendSend
• ORM (procedure updated)ORM (procedure updated)
March, 2004 IHE Cardiology Technical Committee14
DSS/Order Filler Actor (Cont.)DSS/Order Filler Actor (Cont.)
• 4.1 - Patient Registration transaction4.1 - Patient Registration transaction – ReceiveReceive
• A01 (In Patient), A04 (Out Patient), A05 (Pre-Admission), A11 (Cancel A01 (In Patient), A04 (Out Patient), A05 (Pre-Admission), A11 (Cancel Admit), A38 (Cancel Preadmit)Admit), A38 (Cancel Preadmit)
• 4.12 - Patient Update transaction4.12 - Patient Update transaction – ReceiveReceive
• A02 (Patient Transfer), A03 (Discharge), A06(Outpatient becomes A02 (Patient Transfer), A03 (Discharge), A06(Outpatient becomes Inpatient), A07 (Inpatient becomes Outpatient), A08 (Update), A12 Inpatient), A07 (Inpatient becomes Outpatient), A08 (Update), A12 (Cancel Transfer), A13 (Cancel Discharge), A40 (Merge)(Cancel Transfer), A13 (Cancel Discharge), A40 (Merge)
• 4.2 - Placer Order Management transaction4.2 - Placer Order Management transaction – ReceiveReceive
• ORM/NW (New Order), ORM/CA (Cancel Order), ORM/DC (Discontinue)ORM/NW (New Order), ORM/CA (Cancel Order), ORM/DC (Discontinue)
March, 2004 IHE Cardiology Technical Committee15
Modality Worklist Provided [5]
ADT Order Placer
Image Manager
Acquisition Modality
Placer Order Mgmt – New [2]
Department System Scheduler/ Order Filler
Procedure Scheduled [4]
Register/Admit Patient
Create Order
Schedule Procedure and/or Assign Protocol
Patient
Registration [1]
Administrative Normal Administrative Normal Process FlowProcess Flow
March, 2004 IHE Cardiology Technical Committee16
Image Manager
Acquisition Modality
Department System Database/Scheduler
/ Order Filler
Image Archive
Modality Procedure Step Completed [7]
Perform Acquisition
Modality Images Stored [8]
Modality Presentation State Stored [9]
Modality Storage Commitment [10]
Modality Procedure Step In Progress [6]
Images Availability Query [11]
Modality Procedure Step Completed [7]
Modality Procedure Step In Progress [6]
Print Composer
Print Request [23]
Print Server
Procedure PerformanceProcedure PerformanceNormal Process FlowNormal Process Flow
March, 2004 IHE Cardiology Technical Committee17
ADT Order Placer
Patient
Image Manager
Acquisition Modality
Placer Order Mgmt – New [2]
Department System Scheduler/ Order Filler
Register/ Admit Patient
Create Order
Modify Patient
Patient Update [12]
Registration [1]
Patient
Update [12]
Patient UpdatePatient UpdateBefore Order Entry Before Order Entry
March, 2004 IHE Cardiology Technical Committee18
ADT Order Placer
Image Manager
Acquisition Modality
Placer Order Mgmt – New [2]
Department System Scheduler/ Order Filler
Admit/ Register Patient
Create Order
Modify Patient
Patient
Registration [1]
Patient
Update [12]
Patient Update [12]
Patient UpdatePatient UpdateAfter Order Entry After Order Entry
March, 2004 IHE Cardiology Technical Committee19
Modality Worklist Provided [5]
ADT Order Placer
Patient Registration [1]
Image Manager
Acquisition Modality
Placer Order Mgmt – New [2]
Department System Scheduler/ Order
Filler
Procedure Scheduled [4]
Register/Admit Patient
Create Order
Schedule Procedure and/or Assign Protocol
Patient Update [12]
Modify Patient Patient
Update [12]
Patient UpdatePatient UpdateAfter Procedure SchedulingAfter Procedure Scheduling
March, 2004 IHE Cardiology Technical Committee20
Order ReplacementOrder ReplacementBy the Order PlacerBy the Order Placer
Modality Worklist Provided [5]
ADT Order Placer
Image Manager
Acquisition Modality
Placer Order Mgmt - Cancel [2]
Department System Scheduler/ Order Filler
Procedure Update [13]
Cancel Order
Modality Worklist Provided [5]
Procedure Scheduled [4]
Create Order
Placer Order Mgmt - New [2]
March, 2004 IHE Cardiology Technical Committee21
Order ReplacementOrder ReplacementBy the DSS/Order FillerBy the DSS/Order Filler
Modality Worklist Provided [5]
Procedure Update [13]
Modality Worklist Provided [5]
Filler Order Mgmt - Cancel [3]
Procedure Scheduled [4]
Order Cancelled
Filler Order Mgmt – New [3]
Create Order
ADT Order Placer
Image Manager
Acquisition Modality
Department System Scheduler/ Order Filler
March, 2004 IHE Cardiology Technical Committee22
Image Information ManagementImage Information Management• Defined to facilitate communication between Defined to facilitate communication between
IS, PACS and Modality productsIS, PACS and Modality products
• DICOM services in use are:DICOM services in use are:– Modality Worklist Management (MWL)Modality Worklist Management (MWL)
– Modality Performed Procedure Step (PPS)Modality Performed Procedure Step (PPS)
– StorageStorage
– Storage CommitmentStorage Commitment
– Query/RetrieveQuery/Retrieve
March, 2004 IHE Cardiology Technical Committee
IHE Scheduled Workflow ConceptsIHE Scheduled Workflow Concepts
PROCEDURE STEPPROCEDURE STEP : : The smallest unit of work in the workflow:The smallest unit of work in the workflow:
ScheduledScheduled Procedure Step: Procedure Step: ‘A unit of work ‘A unit of work to do’to do’ PerformedPerformed
Procedure Step: Procedure Step: ‘A unit of work ‘A unit of work donedone’’
IHE has addressed this and other workflow processes by selectingIHE has addressed this and other workflow processes by selecting
three UNAMBIGUOUS three UNAMBIGUOUS HL7/DICOM TERMS : TERMS :
ORDERORDER : : A request for healthcare A request for healthcare
serviceservice
REQUESTED PROCEDUREREQUESTED PROCEDURE : : Units of work resulting in Units of work resulting in one Reportone Reportwithwith associated codified, billable acts associated codified, billable acts
March, 2004 IHE Cardiology Technical Committee
IHE Radiology Addressed this IHE Radiology Addressed this ProblemProblem
This 3 level This 3 level wworkflow orkflow sstructuring tructuring cconceptoncept is is useruser orientedoriented::
OORDER:RDER:A request for A request for imagingimaging service service
(Accession Number)(Accession Number)
REQUESTED PROCEDUREREQUESTED PROCEDURE : : Units of work resulting in one Units of work resulting in one ReportReport
with with associated codified, billable actsassociated codified, billable acts(Requested Procedure ID)(Requested Procedure ID)
PROCEDURE STEPPROCEDURE STEP : :The smallest unit of workThe smallest unit of work
in the workflowin the workflow(modality worklist entry)(modality worklist entry)
CLINICIANCLINICIANOR REFERING DOC:OR REFERING DOC:
The Imaging Dept CustomerThe Imaging Dept Customer
RADIOLOGISTRADIOLOGIST : : In Charge of producingIn Charge of producing
thethe ReportReport
TECHNOLOGISTTECHNOLOGIST(and RADIOLOGIST)(and RADIOLOGIST)
In charge of acquiring In charge of acquiring images, etc.images, etc.
March, 2004 IHE Cardiology Technical Committee25
Issues in Adaptation to CardiologyIssues in Adaptation to Cardiology
• Ordering clinician is often also Ordering clinician is often also performing clinician performing clinician
• Multi-modality, with same personnel Multi-modality, with same personnel operating all modalitiesoperating all modalities
• Mandatory pre-procedure and post-Mandatory pre-procedure and post-procedure activitiesprocedure activities
March, 2004 IHE Cardiology Technical Committee
Normal WorkflowNormal WorkflowTypical workflow: Typical workflow: One OrderOne Order – – One ProcedureOne Procedure – – One ReportOne Report
ORDERA request for RadiologicService
RequestedProcedure
Radiology Department
One or more series of images
ReportSet of
Codifiable,Billable,
ActsAcquisition Modality
March, 2004 IHE Cardiology Technical Committee
AcquisitionModality
AcquisitionModality
Multiple Modality StepsMultiple Modality Steps
ORDERA request for RadiologicService
Radiology Department
Set of Codifiable,
Billable, ActsOne or more series of images
PerformedProcedure
Step P1
ScheduledProcedure
Step B
RequestedProcedure
1
ScheduledProcedure
Step A
Report
One or more series of images
PerformedProcedure
Step P1
DICOMModality Worklist
DICOMModality Worklist
March, 2004 IHE Cardiology Technical Committee28
Actors and TransactionsActors and Transactions
DepartmentSystem Scheduler
/ Order Filler ImageManager
PerformedProcedure Step
Manager
AcquisitionModality
Modality WorklistProvided
5
Storage
Commitment
10
Modality Images Stored
8
Image Display
ImageArchive
Mod. ProcedureStep In-Progress
/Completed6 7
Modality/Creator.Procedure Step
In-Progress/Completed.
6
20
7
21
Modality/Creator.Procedure Step
In-Progress/Completed.
6
20
7
21
Retrieve Images
16
Query Images
14
March, 2004 IHE Cardiology Technical Committee29
Modality WorklistModality Worklist
March, 2004 IHE Cardiology Technical Committee30
MWL Actors and TransactionMWL Actors and Transaction
DepartmentSystem Scheduler
/ Order Filler ImageManager
PerformedProcedure Step
Manager
AcquisitionModality
Modality WorklistProvided
5
Image Display
ImageArchive
March, 2004 IHE Cardiology Technical Committee31
Modality WorklistModality Worklist• MWL enables modality integration with MWL enables modality integration with
information system’s managed datainformation system’s managed data• Prepare imaging procedure by including Prepare imaging procedure by including
patient, scheduling and medical datapatient, scheduling and medical data(i.e. Patient Name/ID, procedure date/time, (i.e. Patient Name/ID, procedure date/time, procedure codes, Accession Number, procedure codes, Accession Number, Requested Procedure ID.…)Requested Procedure ID.…)
• Avoids typing errors by fixing data entry Avoids typing errors by fixing data entry problems at the source of image creationproblems at the source of image creation
• MWL is a “one way trip” (i.e. IS to Modality)MWL is a “one way trip” (i.e. IS to Modality)
Not only to include HIS/RIS Data in DICOM Images, Not only to include HIS/RIS Data in DICOM Images, but to enable the workflow: “acquisition work to do”but to enable the workflow: “acquisition work to do”
Not only to include HIS/RIS Data in DICOM Images, Not only to include HIS/RIS Data in DICOM Images, but to enable the workflow: “acquisition work to do”but to enable the workflow: “acquisition work to do”
March, 2004 IHE Cardiology Technical Committee32
C-FIND-RQ (with matching and return keys)C-FIND-RQ (with matching and return keys)
C-FIND-RSP (one per match plus final response)C-FIND-RSP (one per match plus final response)Modality DSS/
Order Filler
Modality WorklistModality Worklist
• Explicit definition of required matching and return Explicit definition of required matching and return keys for the DSS and Modality. keys for the DSS and Modality. – what the modality may use to filter the response/what the what the modality may use to filter the response/what the
DSS has to match onDSS has to match on– what the modality can ask DSS to return (for display in what the modality can ask DSS to return (for display in
MWL)/what the DSS shall be able to returnMWL)/what the DSS shall be able to return
March, 2004 IHE Cardiology Technical Committee33
Performed Procedure StepPerformed Procedure Step
March, 2004 IHE Cardiology Technical Committee34
PPS Actors and TransactionsPPS Actors and Transactions
DepartmentSystem Scheduler
/ Order Filler ImageManager
PerformedProcedure Step
Manager
AcquisitionModality
Image Display
ImageArchive
Mod. ProcedureStep In-Progress
/Completed6 7
Modality/Creator.Procedure Step
In-Progress/Completed.
6
20
7
21
Modality/Creator.Procedure Step
In-Progress/Completed.
6
20
7
21
March, 2004 IHE Cardiology Technical Committee35
Performed Procedure StepPerformed Procedure Step• Applies to ModalityApplies to Modality• Convey details about procedure step(s) performedConvey details about procedure step(s) performed• Conveys detailed statuses such as “in progress”, Conveys detailed statuses such as “in progress”,
“completed” and “discontinued”“completed” and “discontinued”• Provides “return trip” feedback such as:Provides “return trip” feedback such as:
– Scheduled information obtained via MWLScheduled information obtained via MWL– What, when, and how was the procedure performedWhat, when, and how was the procedure performed– Accession Number, Patient Name/ID, procedure step codesAccession Number, Patient Name/ID, procedure step codes– List of images acquired/created, Study Instance UID ….List of images acquired/created, Study Instance UID ….
Not only tells that the performed step is complete, Not only tells that the performed step is complete, But closes the workflow: “acquisition/creation work done”But closes the workflow: “acquisition/creation work done”
Not only tells that the performed step is complete, Not only tells that the performed step is complete, But closes the workflow: “acquisition/creation work done”But closes the workflow: “acquisition/creation work done”
Images StoredImages Stored
March, 2004 IHE Cardiology Technical Committee37
Images Stored Actors and TransactionsImages Stored Actors and Transactions
DepartmentSystem Scheduler
/ Order Filler ImageManager
PerformedProcedure Step
Manager
AcquisitionModality
Modality Images Stored
8
Image Display
ImageArchive
March, 2004 IHE Cardiology Technical Committee38
Images StoredImages Stored
• Applies to Modality and Image CreatorApplies to Modality and Image Creator• Scheduled Procedure Step and Requested Scheduled Procedure Step and Requested
Procedure information is recorded.Procedure information is recorded.
C-STORE (Images Stored)C-STORE (Images Stored)Modality orImage Creator
Image Archive
March, 2004 IHE Cardiology Technical Committee39
Storage CommitmentStorage Commitment
March, 2004 IHE Cardiology Technical Committee40
Storage Commitment Actors and TransactionsStorage Commitment Actors and Transactions
DepartmentSystem Scheduler
/ Order Filler ImageManager
PerformedProcedure Step
Manager
AcquisitionModality
Storage
Commitment
10
Image Display
ImageArchive
March, 2004 IHE Cardiology Technical Committee41
Storage CommitmentStorage Commitment
• Modalities obtain explicit agreement from a Modalities obtain explicit agreement from a storage device (i.e. archive, etc.) that images storage device (i.e. archive, etc.) that images (and other objects) will be reliably stored(and other objects) will be reliably stored
• The duration of storage is defined by the The duration of storage is defined by the storage device productstorage device product
• Facilitates automated or simplified deletion of Facilitates automated or simplified deletion of images on modalities, workstations, etc.images on modalities, workstations, etc.
Avoids accidental deletion of images on Avoids accidental deletion of images on modalities and workstationsmodalities and workstations
Avoids accidental deletion of images on Avoids accidental deletion of images on modalities and workstationsmodalities and workstations
March, 2004 IHE Cardiology Technical Committee42
C-STORE operations ….C-STORE operations ….
N-ACTION - (list of referenced image UIDs)N-ACTION - (list of referenced image UIDs)
N-EVENT-REPORT - (success or failure)N-EVENT-REPORT - (success or failure)
Image Manager
Storage Commit. - Push ModelStorage Commit. - Push Model
• Images (or objects) are pushed to storage deviceImages (or objects) are pushed to storage device• N-ACTION provides a list of UIDs for objects to be N-ACTION provides a list of UIDs for objects to be
reliably stored (may be different AE than storage)reliably stored (may be different AE than storage)• N-EVENT-REPORT confirmation from Storage to N-EVENT-REPORT confirmation from Storage to
ModalityModality• Implementations must design for transactions being Implementations must design for transactions being
on multiple associationson multiple associations• When N-EVENT-REPORT is sent by Storage Device When N-EVENT-REPORT is sent by Storage Device
is product dependent and may be hours after N-is product dependent and may be hours after N-ACTIONACTION
Modality orImage Creator
March, 2004 IHE Cardiology Technical Committee43
Image Query/RetrieveImage Query/Retrieve
March, 2004 IHE Cardiology Technical Committee44
DepartmentSystem Scheduler
/ Order Filler ImageManager
PerformedProcedure Step
Manager
AcquisitionModality
Image Display
ImageArchive
Retrieve Images
16
Query Images
14
Query/Retrieve Actors and TransactionQuery/Retrieve Actors and Transaction
March, 2004 IHE Cardiology Technical Committee45
Query Retrieve of ImagesQuery Retrieve of Images
• Defines Matching keys for response filtering Defines Matching keys for response filtering by Image Archiveby Image Archive
• Defines Return keys to be requested by Defines Return keys to be requested by Image DisplayImage Display
• Defines Returned attributes by Image ArchiveDefines Returned attributes by Image Archivein query responsesin query responses
• Defines Returned attributes required to be Defines Returned attributes required to be displayed on Image Displaydisplayed on Image Display
C-FIND-RQ (with matching and return keys)C-FIND-RQ (with matching and return keys)
C-FIND-RSP (matches with return keys)C-FIND-RSP (matches with return keys)ImageDisplay
Image Archive
March, 2004 IHE Cardiology Technical Committee46
IHE Generic IHE Generic Keys for Keys for Query Query
Retrieve of:Retrieve of:- Images- Images
- SR- SR
Query Keys Matching Query Keys ReturnAttributes Name Tag
SCU SCP SCU SCP
Study Level
Study Date (0008,0020) R+ R R+ R
Study Time (0008,0030) R+ R R+ R
Accession Number (0008,0050) R+ R R+ R
Patient Name (0010,0010) R+ R R+ R
Patient ID (0010,0020) R+ R R+ R
Study ID (0020,0010) R+ R R+ R
Study Instance UID (0020,000D) R+ R O R
Modalities in Study (0008,0061) R+ R+ R+ R+
Referring Physician’s Name (0008,0090) R+ R+ R+ R+
Patient’s Birth Date (0010,0030) O O R+ R+
Patient’s Sex (0010,0040) O O R+ R+
Number of Study Related Series (0020,1206) N/A N/A O R+
Number of Study Related Instances (0020,1208) N/A N/A O R+
Series Level
Modality (0008,0060) R+ R R+ R
Series Number (0020,0011) R+ R R+ R
Series Instance UID (0020,000E) R+ R O R
Number of Series Related Instances (0020,1209) N/A N/A O R
Request Attribute Sequence (0040,0275) R+ R+ R+ R+
>Requested Procedure ID (0040,1001) R+ R+ R+ R+
>Scheduled Procedure Step ID (0040,0009) R+ R+ R+ R+
Performed Procedure Step Start Date (0040,0244) R + R+ R+ R+
Performed Procedure Step Start Time (0040,0245) R + R+ R+ R+
Composite Object Instance Level
Instance Number (0020,0013) R R O R
SOP Instance UID (0008,0018) R+ R O R
SOP Class UID (0008,0016) O R O R+
R = Required by DICOM
R+ = IHE Requirement to be displayed or entered (SCU), to be returned(SCP)
March, 2004 IHE Cardiology Technical Committee47
Image Specific Query Matching Image Specific Query Matching and Return Keysand Return Keys
Query Keys Matching Query Keys ReturnAttribute Name Tag
SCU SCP SCU SCP
Image Specific Level
Rows (0028,0010) O O O R+
Columns (0028,0011) O O O R+
Bits Allocated (0028,0100) O O O R+
Number of Frames (0028,0008) O O O R+
Patient Information Patient Information ReconciliationReconciliation
March, 2004 IHE Cardiology Technical Committee49
““Trauma Case”Trauma Case”• Emergency Department PatientEmergency Department Patient
• No patient identification:No patient identification:– Patient unconsciousPatient unconscious– Life-threatening situationLife-threatening situation– Urgent procedure - no time for registrationUrgent procedure - no time for registration
• No ordering and/or scheduling of a No ordering and/or scheduling of a procedureprocedure
March, 2004 IHE Cardiology Technical Committee50
““Real-World” ScenarioReal-World” Scenario• The patient is delivered to the The patient is delivered to the
department where it is assigned a department where it is assigned a temporary departmental Patient ID temporary departmental Patient ID and/or name.and/or name.
• The order is then entered by the The order is then entered by the DSS/Order Filler and with this Patient ID DSS/Order Filler and with this Patient ID and/or name, the procedure is and/or name, the procedure is performed on the Acquisition Modality.performed on the Acquisition Modality.
March, 2004 IHE Cardiology Technical Committee51
““Real-World” ScenarioReal-World” Scenario• Image Manager obtains departmental Image Manager obtains departmental
Patient ID from the images or through Patient ID from the images or through MPPS.MPPS.
• DSS/Order Filler sends Order message DSS/Order Filler sends Order message to the Order Filler.to the Order Filler.
• ADT does not know about departmental ADT does not know about departmental Patient IDPatient ID
March, 2004 IHE Cardiology Technical Committee52
““Real-World” ScenarioReal-World” Scenario• When ADT eventually registers or reconciles When ADT eventually registers or reconciles
patient information, it sends messages to all patient information, it sends messages to all systems.systems.
• EACH system has to perform reconciliation EACH system has to perform reconciliation of departmental patient record to the one of departmental patient record to the one provided by ADT.provided by ADT.
• Multiple points of reconciliation!Multiple points of reconciliation!
• Even worse when more than one departmentEven worse when more than one department
March, 2004 IHE Cardiology Technical Committee53
Current problems Current problems
• Unidentified patient’s information must Unidentified patient’s information must be properly entered into all systems, be properly entered into all systems, both enterprise-wide and departmentalboth enterprise-wide and departmental
• High possibility of error while entering High possibility of error while entering patient information into the systems by patient information into the systems by handhand
• High possibility of mismatch of local High possibility of mismatch of local information with that provided by ADTinformation with that provided by ADT
March, 2004 IHE Cardiology Technical Committee54
Current problems - cont’dCurrent problems - cont’d
• Each system will have to perform Each system will have to perform manual merge of initial patient record manual merge of initial patient record into one supplied by ADTinto one supplied by ADT
• Multiple points of reconciliation - high Multiple points of reconciliation - high risk possibility of data being risk possibility of data being unsynchronizedunsynchronized
• High possibility of mismatch of local High possibility of mismatch of local information with that provided by ADTinformation with that provided by ADT
March, 2004 IHE Cardiology Technical Committee55
Unidentified Patient Use CasesUnidentified Patient Use Cases• Local policy calls for ADT to pre-register Local policy calls for ADT to pre-register
ER patients (“John Doe”, “Jane Doe”):ER patients (“John Doe”, “Jane Doe”):– Case 1: Unidentified Patient registered at Case 1: Unidentified Patient registered at
ADT and order is placed at Order Placer.ADT and order is placed at Order Placer.– Case 2: Unidentified Patient registered at Case 2: Unidentified Patient registered at
ADT and order is placed at DSS/Order ADT and order is placed at DSS/Order Filler.Filler.
– Case 3: Unidentified Patient registered at Case 3: Unidentified Patient registered at ADT but acquisition completed at Modality ADT but acquisition completed at Modality prior to order.prior to order.
March, 2004 IHE Cardiology Technical Committee56
Unidentified Patient Use CasesUnidentified Patient Use Cases• Local policy allows departments to Local policy allows departments to
register ER patients with Departmental register ER patients with Departmental IDs:IDs:– Case 4: Unidentified Patient assigned Case 4: Unidentified Patient assigned
temporary Departmental ID and scheduled temporary Departmental ID and scheduled at DSS/Order Filler.at DSS/Order Filler.
– Case 5: Image Acquisition completed prior Case 5: Image Acquisition completed prior to assigning temporary Departmental ID or to assigning temporary Departmental ID or Order (Patient ID entered at the Modality).Order (Patient ID entered at the Modality).
March, 2004 IHE Cardiology Technical Committee57
Unidentified Patient - Case 1Unidentified Patient - Case 1ADT Order
Placer
ImageManager Modality
MWL Provided [5]
Department SystemDatabase/Scheduler/
Order Filler
Placer Order Mgmt
NewOrder [2]
ProcedureScheduled [4]
Patient Reconciliation
J.Doe -> J.Smith
PatientUpdate [12]
Schedule Procedure
ImagesAcquired
Modality ProcedureStep Completed [7]
Modality ProcedureStep Completed [7]
Register J.Doe
Patient
Update [12]
Patient
Registration [1]
March, 2004 IHE Cardiology Technical Committee58
Patient Name/ID Path - Case 1Patient Name/ID Path - Case 1Transaction Patient ID Protocol & Field Prior Patient ID (HL7)
Register J.Doe (Temp_123)
A01 (ADT -> OP) Temp_123^^^ADT_Issuer HL7 (PID-3) N/A
A01 (ADT -> OF) Temp_123^^^ADT_Issuer HL7 (PID-3) N/A
ORM (OP->OF) Temp_123^^^ADT_Issuer HL7 (PID-3) N/A
ORM (OF->IM) Temp_123^^^ADT_Issuer HL7 (PID-3) N/A
DICOM MWL
(OF -> Modality)
Temp_123 DICOM (0010,0020) N/A
PPS (Modality ->PPSM)
Temp_123 DICOM (0010,0020) N/A
PPS (PPSM -> IM) Temp_123 DICOM (0010,0020) N/A
PPS (PPSM -> OF) Temp_123 DICOM (0010,0020) N/A
ADT reconciles J.Doe(Temp_123) ->J.Smith(456)
A40 (ADT -> OF) 456^^^ADT_Issuer HL7 (PID-3) 123^^^ADT_Issuer
A40 (OF->IM) 456^^^ADT_Issuer HL7 (PID-3) 123^^^ADT_Issuer
A40 (ADT -> OP) 456^^^ADT_Issuer HL7 (PID-3) 123^^^ADT_Issuer
March, 2004 IHE Cardiology Technical Committee59
Unidentified Patient - Case 2Unidentified Patient - Case 2ADT Order
Placer
ImageManager Modality
MWL Provided [5]
Department SystemDatabase/Scheduler/
Order Filler
Filler Order Mgmt
New Order[3]
ProcedureScheduled [4]
Patient Reconciliation
J.Doe -> J.Smith
PatientUpdate [12]
Schedule Procedure
ImagesAcquired
Modality ProcedureStep Completed [7]
Modality ProcedureStep Completed [7]
Register J.Doe
Patient
Update [12]
Patient
Registration [1]
March, 2004 IHE Cardiology Technical Committee60
Patient Name/ID Path - Case 2Patient Name/ID Path - Case 2Transaction Patient ID Protocol & Field Prior Patient ID (HL7)
Register J.Doe (Temp_123)
A01 (ADT -> OP) Temp_123^^^ADT_Issuer HL7 (PID-3) N/A
A01 (ADT -> OF) Temp_123^^^ADT_Issuer HL7 (PID-3) N/A
ORM (OF->OP) Temp_123^^^ADT_Issuer HL7 (PID-3) N/A
ORR (OP->OF) Temp_123^^^ADT_Issuer HL7 (PID-3) N/A
ORM (OF->IM) Temp_123^^^ADT_Issuer HL7 (PID-3) N/A
DICOM MWL
(OF -> Modality)
Temp_123 DICOM (0010,0020) N/A
PPS (Modality ->PPSM)
Temp_123 DICOM (0010,0020) N/A
PPS (PPSM -> IM) Temp_123 DICOM (0010,0020) N/A
PPS (PPSM -> OF) Temp_123 DICOM (0010,0020) N/A
ADT reconcilse J.Doe(Temp_123) ->J.Smith(456)
A40 (ADT -> OF) 456^^^ADT_Issuer HL7 (PID-3) 123^^^ADT_Issuer
A40 (OF->IM) 456^^^ADT_Issuer HL7 (PID-3) 123^^^ADT_Issuer
A40 (ADT -> OP) 456^^^ADT_Issuer HL7 (PID-3) 123^^^ADT_Issuer
March, 2004 IHE Cardiology Technical Committee61
Unidentified Patient - Case 3Unidentified Patient - Case 3ADT Order
Placer
ImageManager Modality
Department SystemDatabase/Scheduler/
Order Filler
Filler Order Mgmt
New Order [3]
ProcedureScheduled [4]
Patient Reconciliation
J.Doe -> J.Smith
PatientUpdate [12]
Schedule Procedure
ImagesAcquired
Modality ProcedureStep Completed [7]
Modality ProcedureStep Completed [7]
Register J.Doe
Patient
Update [12]
Patient
Registration [1]
March, 2004 IHE Cardiology Technical Committee62
Patient Name/ID Path - Case 3Patient Name/ID Path - Case 3Transaction Patient ID Protocol & Field Prior Patient ID (HL7)
Register J.Doe (Temp_123)
A01 (ADT -> OP) Temp_123^^^ADT_Issuer HL7 (PID-3) N/A
A01 (ADT -> OF) Temp_123^^^ADT_Issuer HL7 (PID-3) N/A
Temp_123 manually entered at the Modality
PPS (Modality ->PPSM)
Temp_123 DICOM (0010,0020) N/A
PPS (PPSM -> IM) Temp_123 DICOM (0010,0020) N/A
IM recognizes unscheduled MPPS and assumes assigning authority “ADT_Issuer”
PPS (PPSM -> OF) Temp_123 DICOM (0010,0020) N/A
OF recognizes unscheduled MPPS with valid Patient ID and assumes assigning authority “ADT_Issuer”
ORM (OF->OP) Temp_123^^^ADT_Issuer HL7 (PID-3) N/A
ORR (OP->OF) Temp_123^^^ADT_Issuer HL7 (PID-3) N/A
ORM (OF->IM) Temp_123^^^ADT_Issuer HL7 (PID-3) N/A
ADT reconciles J.Doe(Temp_123) ->J.Smith(456)
A40 (ADT -> OF) 456^^^ADT_Issuer HL7 (PID-3) 123^^^ADT_Issuer
A40 (OF->IM) 456^^^ADT_Issuer HL7 (PID-3) 123^^^ADT_Issuer
A40 (ADT -> OP) 456^^^ADT_Issuer HL7 (PID-3) 123^^^ADT_Issuer
March, 2004 IHE Cardiology Technical Committee63
Unidentified Patient - Case 4Unidentified Patient - Case 4ADT Order
Placer
ImageManager Modality
MWL Provided [5]
Department SystemDatabase/Scheduler/
Order Filler
Filler Order Mgmt
New Order [3]
ProcedureScheduled [4]
Patient Reconciliation
J.Doe -> J.Smith
PatientUpdate [12]
Schedule Procedure for J.Doe
ImagesAcquired
Modality ProcedureStep Completed [7]
Modality ProcedureStep Completed [7]
Register J.Smith
Patient
Registration [1]
March, 2004 IHE Cardiology Technical Committee64
Patient Name/ID Path - Case 4Patient Name/ID Path - Case 4Transaction Patient ID Protocol & Field Prior Patient ID (HL7)
OF creates J.Doe (Dept_123)
ORM (OF->IM) Dept_123^^^ADT_Issuer HL7 (PID-3) N/A
DICOM MWL(OF->Modality)
Dept_123 DICOM (0010,0020)
PPS (Modality ->PPSM)
Dept_123 DICOM (0010,0020) N/A
PPS (PPSM -> IM) Dept_123 DICOM (0010,0020) N/A
IM recognizes unscheduled MPPS and assumes assigning authority “OF_Issuer”
PPS (PPSM -> OF) Dept_123 DICOM (0010,0020) N/A
OF recognizes unscheduled MPPS with valid Patient ID and assumes assigning authority “OF_Issuer”
ADT registers J.Smith (456)
A01 (ADT -> OP) Dept_123^^^ADT_Issuer HL7 (PID-3) N/A
A01 (ADT -> OF) Dept_123^^^ADT_Issuer HL7 (PID-3) N/A
OF reconciles J.Doe(Dept_123) ->J.Smith(456)
A40 (OF->IM) 456^^^ADT_Issuer HL7 (PID-3) Dept_123^^^OF_Issuer
ORM (OF->OP) 456^^^ADT_Issuer HL7 (PID-3) N/A
ORR (OP->OF) 456^^^ADT_Issuer HL7 (PID-3) N/A
ORM (OF->IM) 456^^^ADT_Issuer HL7 (PID-3) N/A
March, 2004 IHE Cardiology Technical Committee65
Unidentified Patient - Case 5Unidentified Patient - Case 5ADT Order
Placer
ImageManager Modality
Department SystemDatabase/Scheduler/
Order Filler
Filler Order Mgmt
New Order [3]ProcedureScheduled [4]
Patient Reconciliation
J.Doe -> J.Smith
PatientUpdate [12]
Schedule Procedure
ImagesAcquired for J.Doe
Modality ProcedureStep Completed [7]
Modality ProcedureStep Completed [7]
Register J.Smith
Patient
Registration [1]
March, 2004 IHE Cardiology Technical Committee66
Patient Name/ID Path - Case 5Patient Name/ID Path - Case 5Transaction Patient ID Protocol & Field Prior Patient ID (HL7)
Modality performs procedure J.Doe (Dept_123)
PPS (Modality ->PPSM)
Dept_123 DICOM (0010,0020) N/A
PPS (PPSM -> IM) Dept_123 DICOM (0010,0020) N/A
IM recognizes unscheduled MPPS and assumes configured assigning authority [“OF_Issuer”]
PPS (PPSM -> OF) Dept_123 DICOM (0010,0020) N/A
OF recognizes unscheduled MPPS with invalid Patient ID and assumes assigning authority [“OF_Issuer”]
ADT registers J.Smith (456)
A01 (ADT -> OP) Dept_123^^^ADT_Issuer HL7 (PID-3) N/A
A01 (ADT -> OF) Dept_123^^^ADT_Issuer HL7 (PID-3) N/A
OF reconciles J.Doe(Dept_123) ->J.Smith(456)
A40 (OF->IM) 456^^^ADT_Issuer HL7 (PID-3) Dept_123^^^OF_Issuer
ORM (OF->OP) 456^^^ADT_Issuer HL7 (PID-3) N/A
ORR (OP->OF) 456^^^ADT_Issuer HL7 (PID-3) N/A
ORM (OF->IM) 456^^^ADT_Issuer HL7 (PID-3) N/A
March, 2004 IHE Cardiology Technical Committee67
System RequirementsSystem Requirements• Participating systems - ADT, Order Participating systems - ADT, Order
Placer, Order Filler and Image Manager Placer, Order Filler and Image Manager communicate updates via HL7communicate updates via HL7
• All systems must support ADT^A40:All systems must support ADT^A40:– PID-3 field for new Patient IDPID-3 field for new Patient ID– MRG-1 field for old Patient IDMRG-1 field for old Patient ID
• Data Type for Patient ID must be CXData Type for Patient ID must be CX
• Assigning Authority must be included Assigning Authority must be included with Patient IDwith Patient ID
March, 2004 IHE Cardiology Technical Committee68
System RequirementsSystem Requirements• Order Filler and Image Manager may Order Filler and Image Manager may
encounter Patient ID without assigning encounter Patient ID without assigning authority conveyed in MPPS via DICOMauthority conveyed in MPPS via DICOM
• OF and IM will assume assigning OF and IM will assume assigning authority (configurable, but the same)authority (configurable, but the same)
• OF and IM shall be able to recognize OF and IM shall be able to recognize valid Patient IDvalid Patient ID
March, 2004 IHE Cardiology Technical Committee69
Policy RequirementsPolicy Requirements• Institution shall choose whether pre-Institution shall choose whether pre-
registration of ER patients happens at registration of ER patients happens at the ADT levelthe ADT level
• OF and IM shall be configured to the OF and IM shall be configured to the same assigning authoritysame assigning authority
• Order Filler shall be able to distinguish Order Filler shall be able to distinguish valid Patient ID from invalid onevalid Patient ID from invalid one
• In Cases 4 and 5, OF must reconcile In Cases 4 and 5, OF must reconcile patient info before orderingpatient info before ordering