Integrating the Healthcare Enterprise - IHE in Europe

Integrating the Healthcare EnterpriseIHE Integration Profiles– SCHEDULED WORKFLOW –• Introduction• Part I – HL7 ( HIS & RIS – Administrative Workflow)• Part II – DICOM ( Image Information Management )IHE Integration ProfileSCHEDULED WORKFLOWDr. Nikolaus WirszSiemens Medical Solutions1IHE – Europe WorkshopAachen – 27 January 2002

• IntroductionIHE Integration ProfileSCHEDULED WORKFLOW2IHE – Europe WorkshopAachen – 27 January 2002

The Radiology WorkflowIHE Integration ProfileSCHEDULED WORKFLOW3IHE – Europe WorkshopAachen – 27 January 2002

Key IHE Concepts• Generalized Systems=> Actors• Interactions between Actors => Transactions• Problem/Solution Scenarios => Integration Profiles• For each Integration Profile:• the context is described (which real-world problem)• the actors are defined (what systems are involved)• the transactions are defined (what must they do)IHE Integration ProfileSCHEDULED WORKFLOW4IHE – Europe WorkshopAachen – 27 January 2002

IHE & DICOM / HL7• Standards are vital (HL7, DICOM, ICD, …)– They provide tools & technologies• But Standards alone are insufficient– They are open to interpretation– There is room for optional variations– They avoid specifying how to apply them toparticular real world scenariosIHE Integration ProfileSCHEDULED WORKFLOW5IHE – Europe WorkshopAachen – 27 January 2002

How is IHE related to Standards?• Profiles are packaging• IHE attacks real world radiology integrationproblems• HL7 and DICOM provide dictionaries• IHE defines a “phrasebook” that solves real worldproblems by assembling pieces provided byDICOM/HL7IHE Integration ProfileSCHEDULED WORKFLOW6IHE – Europe WorkshopAachen – 27 January 2002

IHE System Transactions OverviewPatient RegistrationADTPatient RegistrationOrder PlacerPatient UpdateStorageCommitImage CreatorFiller OrderManagementDepartmentSystem Scheduler– Order Filler –Placer OrderManagementProcedure ScheduledPatient UpdateProcedure UpdateQ /RImagesImage ManagerImage DisplayQ /R KeyImageNoteImage ArchiveQ /RPresentationSatesImagesStoredPresent.StateStoredKeyImageNoteStoredPPSIn-Progress/ CompletedModality WorklistImages Availability QueryPerformedProcedure StepManagerPPSIn-Progress/ CompletedStorageCommitImagesStoredAcquisitionModalityPresent.StateStoredKeyImageNoteStoredPPSIn-Progress/ CompletedIHE Integration ProfileSCHEDULED WORKFLOW7IHE – Europe WorkshopAachen – 27 January 2002

IHE System Transactions OverviewPatient RegistrationADTPatient RegistrationOrder PlacerHISPatient UpdateStorageCommitImage CreatorFiller OrderManagementDepartmentSystem Scheduler– Order Filler –Placer OrderManagementRISPPSIn-Progress/ CompletedModality WorklistProcedure ScheduledImages Availability QueryPerformedProcedure StepManagerPatient UpdateProcedure UpdatePPSIn-Progress/ CompletedImage DisplayQ /R KeyImageQ /RIMAGING:NotePresentationQ /RSatesImages•PACS•WorkstationsImage ArchiveImage Manager•ModalitiesStorageCommitImagesStoredAcquisitionModalityImagesStoredPresent.StateStoredPresent.StateStoredKeyImageNoteStoredKeyImageNoteStoredPPSIn-Progress/ CompletedIHE Integration ProfileSCHEDULED WORKFLOW8IHE – Europe WorkshopAachen – 27 January 2002

IHE = A Standards Harmonization ApproachHIS RIS PACS ModalityHIS HL7 HL7 –– ––RIS HL7 HL7 HL7 / DICOM DICOMPACS –– HL7 / DICOM DICOM DICOMModality –– DICOM DICOM DICOMIHE Goes Beyond StandardsIHE =+ Multi-Vendor+ Workflow-Driven+ INTEGRATIONbased on established medical IT StandardsIHE Integration ProfileSCHEDULED WORKFLOW9IHE – Europe WorkshopAachen – 27 January 2002

The 2 Workflow Basics in IHE1) Scheduled Workflow:Enterprise Process Steps Under Normal Conditions:Admission / Registration, Order Entry,Scheduling, Images Acquisition, ...2) Patient Information Reconciliation:Exception HandlingExample: Image Acquisition Completed foran Unidentified PatientIHE Integration ProfileSCHEDULED WORKFLOW10IHE – Europe WorkshopAachen – 27 January 2002

IHE Year 4 Integration ProfilesScheduled WorkflowAdmit, order, schedule, acquire images,notify of completed stepsPatient InformationReconciliationUnknown patients andunscheduled ordersPost- ProcessingWorkflowSchedule, perform, &notify image processing& CAD stepsCharge PostingCollection of billableprocedure detailsConsistent Presentation ofImagesHardcopy and softcopy grayscalepresentation statePresentation of GroupedProceduresSubset of a single acquisitionKey ImageNotesFlag significantimagesAccess to Radiology InformationConsistent access to images and reportsSimple Image andNumeric ReportsSimple reports with imagelinks and, optionally,measurementsBasic SecurityAudit Trail Consolidation & Node AuthenticationIHE Integration ProfileSCHEDULED WORKFLOW11IHE – Europe WorkshopAachen – 27 January 2002

Scheduled WorkflowPatient RegistrationADTPatient RegistrationOrder PlacerImage CreatorFiller OrderManagementPlacer OrderManagementStorageCommitQ /RImagesImage DisplayImagesStoredDepartmentSystem Scheduler– Order Filler –Image ArchiveProcedure ScheduledImage ManagerPPSIn-Progress/ CompletedModality WorklistImages Availability QueryPerformedProcedure StepManagerPPSIn-Progress/ CompletedStorageCommitImagesStoredAcquisitionModalityPPSIn-Progress/ CompletedIHE Integration ProfileSCHEDULED WORKFLOW12IHE – Europe WorkshopAachen – 27 January 2002

IHEActors&Transactionsin theScheduledWorkflowProfilePerformedProcedureStep ManagerPt Registration: 1Pt Update: 12Order Filler↑ 6: Modality PPS in Progress↑ 7: Modality PPS Completed↑ 20: Creator PPS in Progress↑ 21: Creator PPS Completed↓ 20: Creator PPS in Progress↓ 21: Creator PPS Completed→ 6: Modality PPS in Progress→ 7: Modality PPS Completed→ 20: Creator PPS in Progress→ 21: Creator PPS Completed↓↓ADT← 2: Placer Order Management→ 3: Filler Order Management↓ 4: Procedure Scheduled↑ 11: Image Availability Query↓ 12: Patient Update↓ 13: Procedure UpdateStorageCommitment: 10Storage Commitment: 10↑↓ImageManagerImage Creator↓ 1: Pt registration↓ 12: Pt Update↓ 18: Creator Image Stored↓ 19: Creator GSPS Stored↓ 29: Key Image Notes StoredImageArchive_ 1: Pt Registration_ 12: Pt UpdateOrder Placer↑ 8: Modality Image Stored↑ 9: Modality GSPS Stored↑ 29: Key Image Notes StoredImage DisplayMaster Patient Index↑ 14: Query Images↑ 15: Query GSPS↑ 16: Retrieve Images↑ 17: Retrieve GSPS↑ 30: Query Key Image Notes↑ 31: Retrieve Key Image Notes← 6: Modality PPS in Progress← 7: Modality PPS Completed→ 5: Modality Worklist ProvidedAcquisitionModalityLegend :IHE TransactionOutside the scope of IHE Year 4IHE Integration ProfileSCHEDULED WORKFLOW13IHE – Europe WorkshopAachen – 27 January 2002

IHEActors&Transactionsin theScheduledWorkflowProfile• HL7:PerformedProcedureStep ManagerPt Registration: 1Pt Update: 12Order Filler↑ 6: Modality PPS in Progress↑ 7: Modality PPS Completed↑ 20: Creator PPS in Progress↑ 21: Creator PPS Completed↓ 20: Creator PPS in Progress↓ 21: Creator PPS CompletedIHE Standards Based Transactions→ 6: Modality PPS in Progress-ADT Messages (A01-08, A11-13, → 7: Modality A38, PPS Completed A40)→ 20: Creator PPS in Progress-ORM Messages→ 21: Creator PPS Completed• DICOM:-Modality Worklist Management (MWL)→ 5: Modality Worklist Provided↓↓ADT← 2: Placer Order Management→ 3: Filler Order Management↓ 4: Procedure Scheduled↑ 11: Image Availability Query↓ 12: Patient Update↓ 13: Procedure UpdateStorageCommitment: 10Storage Commitment: 10← 6: Modality PPS in Progress-Modality Performed Procedure Step (MPPS)← 7: Modality PPS Completed-Storage, Storage Commitment-Query/Retrieve↑↓ImageManagerImage CreatorAcquisitionModality↓ 1: Pt registration↓ 12: Pt Update↓ 18: Creator Image Stored↓ 19: Creator GSPS Stored↓ 29: Key Image Notes StoredImageArchive_ 1: Pt Registration_ 12: Pt UpdateOrder Placer↑ 8: Modality Image Stored↑ 9: Modality GSPS Stored↑ 29: Key Image Notes StoredImage DisplayLegend :Master Patient Index↑ 14: Query Images↑ 15: Query GSPS↑ 16: Retrieve Images↑ 17: Retrieve GSPS↑ 30: Query Key Image Notes↑ 31: Retrieve Key Image NotesIHE TransactionOutside the scope of IHE Year 4IHE Integration ProfileSCHEDULED WORKFLOW14IHE – Europe WorkshopAachen – 27 January 2002

• Part I – HL7HIS & RIS – Administrative WorkflowIHE Integration ProfileSCHEDULED WORKFLOW15IHE – Europe WorkshopAachen – 27 January 2002

HL7 Actors in IHEADTPt Registration: 1↓↓ 1: Pt registrationPt Update: 12↓← 2: Placer Order Management↓ 12: Pt UpdateOrder Filler→ 3: Filler Order ManagementOrder Placer↓ 4: Procedure Scheduled↓ 12: Patient Update↓ 13: Procedure UpdateHL7 Actors:• ADT / Patient Registration• Order Placer• DSS / Order Filler• Image ManagerImageManagerIHE Integration ProfileSCHEDULED WORKFLOW16IHE – Europe WorkshopAachen – 27 January 2002

ADT ActorADTPt Registration: 1↓↓ 1: Pt registrationPt Update: 12↓← 2: Placer Order Management↓ 12: Pt UpdateOrder Filler→ 3: Filler Order ManagementOrder Placer↓ 4: Procedure Scheduled↓ 12: Patient Update↓ 13: Procedure UpdateImageManagerIHE Integration ProfileSCHEDULED WORKFLOW17IHE – Europe WorkshopAachen – 27 January 2002

ADT Actor• 1 - Patient Registration transaction– Send• Admit: A01 (In Patient), A04 (Out Patient), A05 (Pre-Admission)• Cancel: A11 (Cancel Admit), A38 (Cancel Preadmit)IHE Integration ProfileSCHEDULED WORKFLOW18IHE – Europe WorkshopAachen – 27 January 2002

ADT Actor (cont.)• 12 - ADT Patient Update transaction– Send• Transfer: A02 (Patient Transfer)• Update Patient Class: A03 (Discharge), A06(Outpatient becomesInpatient), A07 (Inpatient becomes Outpatient)• Update Patient Information: A08 (Update)• Merge Patients: A40 (Merge)• Cancel: A12 (Cancel Transfer), A13 (Cancel Discharge)IHE Integration ProfileSCHEDULED WORKFLOW19IHE – Europe WorkshopAachen – 27 January 2002

Order Placer ActorADTPt Registration: 1↓↓ 1: Pt registrationPt Update: 12↓← 2: Placer Order Management↓ 12: Pt UpdateOrder Filler→ 3: Filler Order ManagementOrder Placer↓ 4: Procedure Scheduled↓ 12: Patient Update↓ 13: Procedure UpdateImageManagerIHE Integration ProfileSCHEDULED WORKFLOW20IHE – Europe WorkshopAachen – 27 January 2002

Order Placer Actor• 2 - Placer Order Management transaction– Send• New Order: ORM/NW (New Order)• Cancel: ORM/CA (Cancel Order), ORM/DC (Discontinue)IHE Integration ProfileSCHEDULED WORKFLOW21IHE – Europe WorkshopAachen – 27 January 2002

Order Placer Actor (cont.)• 1 - Patient Registration transaction– Receive• A01 (In Patient), A04 (Out Patient), A05 (Pre-Admission), A11 (Cancel Admit),A38 (Cancel Preadmit)• 12 - Patient Update transaction– Receive• A02 (Patient Transfer), A03 (Discharge), A06(Outpatient becomes Inpatient),A07 (Inpatient becomes Outpatient), A08 (Update), A12 (Cancel Transfer),A13 (Cancel Discharge), A40 (Merge)• 3 - Filler Order Management transaction– Receive• ORM/SN (New Order), ORM/SC (Status Update), ORM/OC (Cancel Order)IHE Integration ProfileSCHEDULED WORKFLOW22IHE – Europe WorkshopAachen – 27 January 2002

DSS / Order Filler ActorADTPt Registration: 1↓↓ 1: Pt registrationPt Update: 12↓← 2: Placer Order Management↓ 12: Pt UpdateOrder Filler→ 3: Filler Order ManagementOrder Placer↓ 4: Procedure Scheduled↓ 12: Patient Update↓ 13: Procedure UpdateImageManagerIHE Integration ProfileSCHEDULED WORKFLOW23IHE – Europe WorkshopAachen – 27 January 2002

DSS / Order Filler Actor• 3 - Placer Filler Management transaction– Send• New Order: ORM/SN (New Order)• Order Status: ORM/SC (Status Change)• Cancel: ORM/OC (Cancel Order)• 4 - Procedure Scheduled transaction– Send• ORM (procedure scheduled)• 13 - Procedure Updated transaction– Send• ORM (procedure updated)• 12 - Patient Update transaction– Send• A02 (Patient Transfer), A03 (Discharge), A06(Outpatient becomesInpatient), A07 (Inpatient becomes Outpatient), A08 (Update) A40 (Merge)IHE Integration ProfileSCHEDULED WORKFLOW24IHE – Europe WorkshopAachen – 27 January 2002

DSS/Order Filler Actor (Cont.)• 1 - Patient Registration transaction– Receive• A01 (In Patient), A04 (Out Patient), A05 (Pre-Admission), A11 (CancelAdmit), A38 (Cancel Preadmit)• 2 - Placer Order Management transaction– Receive• ORM/NW (New Order), ORM/CA (Cancel Order), ORM/DC (Discontinue)• 12 - Patient Update transaction– Receive• A02 (Patient Transfer), A03 (Discharge), A06(Outpatient becomes Inpatient),A07 (Inpatient becomes Outpatient), A08 (Update), A12 (Cancel Transfer),A13 (Cancel Discharge), A40 (Merge)IHE Integration ProfileSCHEDULED WORKFLOW25IHE – Europe WorkshopAachen – 27 January 2002

DSS / Image Manager ActorADTPt Registration: 1↓↓ 1: Pt registrationPt Update: 12↓← 2: Placer Order Management↓ 12: Pt UpdateOrder Filler→ 3: Filler Order ManagementOrder Placer↓ 4: Procedure Scheduled↓ 12: Patient Update↓ 13: Procedure UpdateImageManagerIHE Integration ProfileSCHEDULED WORKFLOW26IHE – Europe WorkshopAachen – 27 January 2002

Image Manager Actor• 4 - Procedure Scheduled transaction– Receive• ORM (procedure scheduled)• 13 - Procedure Updated transaction– Receive• ORM (procedure updated)• 12 - Patient Update transaction– Receive• A02 (Patient Transfer), A03 (Discharge), A06(Outpatientbecomes Inpatient), A07 (Inpatient becomes Outpatient),A08 (Update) A40 (Merge)IHE Integration ProfileSCHEDULED WORKFLOW27IHE – Europe WorkshopAachen – 27 January 2002

Administrative Normal ProcessFlowADTOrderPlacerDepartment SystemScheduler/ Order FillerImageManagerAcquisitionModalityRegister/AdmitPatientPatientRegistration [1]Create OrderPlacer OrderMgmt – New [2]Schedule Procedure and/orAssign ProtocolProcedureScheduled [4]Modality WorklistProvided [5]IHE Integration ProfileSCHEDULED WORKFLOW28IHE – Europe WorkshopAachen – 27 January 2002

Procedure PerformanceNormal Process FlowDepartment SystemDatabase/Scheduler/ Order FillerImageManagerAcquisitionModalityImageArchivePrintServerModality ProcedureStep In Progress [6]Modality ProcedureStep In Progress [6]PrintComposerModality ProcedureStep Completed [7]Modality ProcedureStep Completed [7]Modality StorageCommitment [10]PerformAcquisitionModality ImagesStored [8]ModalityPresentation StateStored [9]Print Request [23]Images AvailabilityQuery [11]IHE Integration ProfileSCHEDULED WORKFLOW29IHE – Europe WorkshopAachen – 27 January 2002

Patient UpdateBefore Order EntryADTOrderPlacerDepartment SystemScheduler/ Order FillerImageManagerAcquisitionModalityRegister/AdmitPatientPatientRegistration [1]ModifyPatientPatientUpdate [12]Patient Update [12]Create OrderPlacer OrderMgmt – New [2]IHE Integration ProfileSCHEDULED WORKFLOW30IHE – Europe WorkshopAachen – 27 January 2002

Patient UpdateAfter Order EntryADTOrderPlacerDepartment SystemScheduler/ Order FillerImageManagerAcquisitionModalityAdmit/RegisterPatientPatientRegistration [1]Create OrderPlacer OrderMgmt – New [2]ModifyPatientPatientUpdate [12]PatientUpdate [12]IHE Integration ProfileSCHEDULED WORKFLOW31IHE – Europe WorkshopAachen – 27 January 2002

Patient UpdateAfter Procedure SchedulingADTOrderPlacerDepartment SystemScheduler/ OrderFillerImageManagerAcquisitionModalityRegister/AdmitPatientPatientRegistration [1]Create OrderPlacer OrderMgmt – New [2]Schedule Procedure and/orAssign ProtocolProcedureScheduled [4]Modality WorklistProvided [5]ModifyPatientPatientUpdate [12]PatientUpdate [12]IHE Integration ProfileSCHEDULED WORKFLOW32IHE – Europe WorkshopAachen – 27 January 2002

Order ReplacementBy the Order PlacerADTOrderPlacerDepartment SystemScheduler/ Order FillerImageManagerAcquisitionModalityCancel OrderPlacer Order Mgmt- Cancel [2]ProcedureUpdate [13]Modality Worklist Provided [5]Create OrderPlacer OrderMgmt - New [2]ProcedureScheduled [4]Modality Worklist Provided [5]IHE Integration ProfileSCHEDULED WORKFLOW33IHE – Europe WorkshopAachen – 27 January 2002

Order ReplacementBy the DSS/Order FillerADTOrderPlacerDepartment SystemScheduler/ Order FillerImageManagerAcquisitionModalityFiller Order Mgmt- Cancel [3]OrderCancelledProcedureUpdate [13]Modality Worklist Provided [5]Filler OrderMgmt – New [3]CreateOrderProcedureScheduled [4]Modality Worklist Provided [5]IHE Integration ProfileSCHEDULED WORKFLOW34IHE – Europe WorkshopAachen – 27 January 2002

• Part II – DICOMImage Information ManagementIHE Integration ProfileSCHEDULED WORKFLOW35IHE – Europe WorkshopAachen – 27 January 2002

Image Information Management• Defined to facilitate communication between IS,PACS and Modality products• DICOM services in use are:– Modality Worklist Management (MWL)– Modality Performed Procedure Step (PPS)– Storage– Storage Commitment– Query/RetrieveIHE Integration ProfileSCHEDULED WORKFLOW36IHE – Europe WorkshopAachen – 27 January 2002

IHE Scheduled Workflow ConceptsIHE has addressed these and other workflow processes by selectingthree UNAMBIGUOUS HL7/DICOM TERMS :ORDER :A request for radiologic serviceREQUESTED PROCEDURE : Units of work resulting in one Reportwith associated codified, billable actsPROCEDURE STEP : 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’IHE Integration ProfileSCHEDULED WORKFLOWIHE – Europe WorkshopAachen – 27 January 2002

IHE addressed this ProblemThis 3 level workflow structuring concept is user oriented: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)IHE Integration ProfileSCHEDULED WORKFLOWCLINICIANOR REFERING DOC:The Imaging Dept CustomerRADIOLOGIST :In Charge of producingthe ReportTECHNOLOGIST(and RADIOLOGIST)In charge of acquiringimages, etc.IHE – Europe WorkshopAachen – 27 January 2002

Normal WorkflowTypical workflow: One Order – One Procedure – One ReportORDERA request forRadiologicServiceRequestedProcedureRadiology DepartmentAcquisition ModalityReportSet ofCodifiable,Billable,ActsOne or moreseries ofimagesIHE Integration ProfileSCHEDULED WORKFLOWIHE – Europe WorkshopAachen – 27 January 2002

Multiple Modality StepsORDERA request forRadiologicServiceDICOMModality WorklistRequestedProcedure1ScheduledProcedureStep AScheduledProcedureStep BDICOMModality WorklistRadiology DepartmentPerformedProcedureStep P1One or moreseries ofimagesPerformedProcedureAcquisitionStep P1 ModalityOne or moreseries ofimagesReportSet ofCodifiable,Billable, ActsAcquisitionModalityIHE Integration ProfileSCHEDULED WORKFLOWIHE – Europe WorkshopAachen – 27 January 2002

Actors and TransactionsDepartmentSystem Scheduler/ Order FillerStorage 10CommitmentImageManagerQueryImagesRetrieveImages1416Image DisplayImageArchiveImage Creator18CreatorImages Stored620Modality/Creator.Procedure StepIn-Progress/Completed.Modality WorklistProvided511ImageAvailability Query721PerformedProcedure StepManager620Modality/Creator.Procedure StepIn-Progress/Completed.Mod. ProcedureStep In-Progress/Completed6 77218ModalityImages Stored10StorageCommitmentAcquisitionModality20 21Creator ProcedureStep In-Progress/CompletedIHE Integration ProfileSCHEDULED WORKFLOW41IHE – Europe WorkshopAachen – 27 January 2002

Modality WorklistIHE Integration ProfileSCHEDULED WORKFLOW42IHE – Europe WorkshopAachen – 27 January 2002

MWL Actors and TransactionImage DisplayImage CreatorDepartmentSystem Scheduler/ Order FillerImageManagerImageArchiveModality WorklistProvided5PerformedProcedure StepManagerAcquisitionModalityIHE Integration ProfileSCHEDULED WORKFLOW43IHE – Europe WorkshopAachen – 27 January 2002

Modality Worklist• MWL enables modality integration with informationsystem’s managed data• Prepare imaging procedure by including patient,scheduling and medical data(i.e. Patient Name/ID, procedure date/time,procedure codes, Accession Number, RequestedProcedure ID.…)• Avoids typing errors by fixing data entry problemsat the source of image creation• MWL is a “one way trip” (i.e. IS to Modality)Not only to to include HIS/RIS Data in in DICOM Images,but to to enable the workflow: “acquisition work to to do”IHE Integration ProfileSCHEDULED WORKFLOW44IHE – Europe WorkshopAachen – 27 January 2002

Modality WorklistModalityC-FIND-RQ (with matching and return keys)C-FIND-RSP (one per match plus final response)DSS/Order Filler• Explicit definition of required matching and return keys forthe DSS and Modality.– what the modality may use to filter the response/what the DSS hasto match on– what the modality can ask DSS to return (for display in MWL)/whatthe DSS shall be able to returnIHE Integration ProfileSCHEDULED WORKFLOW45IHE – Europe WorkshopAachen – 27 January 2002

Performed Procedure StepIHE Integration ProfileSCHEDULED WORKFLOW46IHE – Europe WorkshopAachen – 27 January 2002

PPS Actors and TransactionsImage DisplayImage CreatorDepartmentSystem Scheduler/ Order FillerImageManagerImageArchive620Modality/Creator.Procedure StepIn-Progress/Completed.721PerformedProcedure StepManager620Modality/Creator.Procedure StepIn-Progress/Completed.Mod. ProcedureStep In-Progress/Completed6 772120 21Creator ProcedureStep In-Progress/CompletedAcquisitionModalityIHE Integration ProfileSCHEDULED WORKFLOW47IHE – Europe WorkshopAachen – 27 January 2002

Performed Procedure Step• Applies to Modality and Image Creator• Convey details about procedure step(s) performed• Conveys detailed statuses such as “in progress”,“completed” and “discontinued”• Provides “return trip” feedback such as:– Scheduled information obtained via MWL– What, when, and how was the procedure performed– Accession Number, Patient Name/ID, procedure step codes,radiation dose values, material management data– List of images acquired/created, Study Instance UID ….Not only tells that the performed step is is complete,But closes the workflow: “acquisition/creation work done”IHE Integration ProfileSCHEDULED WORKFLOW48IHE – Europe WorkshopAachen – 27 January 2002

Performed Procedure StepModality orImageCreatorN-CREATE (scheduled info, status of “in progress”)N-SET (performed info, status of “completed”)DSS orImageManager• Simple Case (1 SPS results in 1 PPS)• Unscheduled Case (0 SPS results in1 PPS)• Append Case (1 SPS results in n PPS)• Group Case (n SPS results in 1 PPS)• Abandoned Case (1 SPS results in 1 abandoned PPS)• Group Case with Presentation of Grouped Procedures (nSPS results in 1+n PPS)IHE Integration ProfileSCHEDULED WORKFLOW49IHE – Europe WorkshopAachen – 27 January 2002

Performed Procedure StepModality orImageCreatorN-CREATE (scheduled info, status of “in progress”)N-SET (performed info, status of “completed”)DSS orImageManager• Simple Case (1 SPS results in 1 PPS)• Unscheduled Case (0 SPS results in1 PPS)• Append Case (1 SPS results in n PPS)Volume II, Appendix A• Group Case (n SPS results in 1 PPS)• Abandoned Case (1 SPS results in 1 abandoned PPS)• Group Case with Presentation of Grouped Procedures (nSPS results in 1+n PPS)IHE Integration ProfileSCHEDULED WORKFLOW50IHE – Europe WorkshopAachen – 27 January 2002

Images StoredIHE Integration ProfileSCHEDULED WORKFLOW51IHE – Europe WorkshopAachen – 27 January 2002

Images Stored Actors and TransactionsImage CreatorImage Display18CreatorImages StoredDepartmentSystem Scheduler/ Order FillerImageManagerImageArchive8ModalityImages StoredPerformedProcedure StepManagerAcquisitionModalityIHE Integration ProfileSCHEDULED WORKFLOW52IHE – Europe WorkshopAachen – 27 January 2002

Images StoredModality orImageCreatorC-STORE (Images Stored)ImageArchive• Applies to Modality and Image Creator• Scheduled Procedure Step and RequestedProcedure information is recorded.IHE Integration ProfileSCHEDULED WORKFLOW53IHE – Europe WorkshopAachen – 27 January 2002

Storage CommitmentIHE Integration ProfileSCHEDULED WORKFLOW54IHE – Europe WorkshopAachen – 27 January 2002

Storage Commitment Actors and TransactionsImage DisplayImage Creator10StorageCommitmentDepartmentSystem Scheduler/ Order FillerImageManagerImageArchivePerformedProcedure StepManager10StorageCommitmentAcquisitionModalityIHE Integration ProfileSCHEDULED WORKFLOW55IHE – Europe WorkshopAachen – 27 January 2002

Storage Commitment• Modalities and image creators obtain explicitagreement from a storage device (i.e. archive,etc.) that images (and other objects) will bereliably stored• The duration of storage is defined by the storagedevice product• Facilitates automated or simplified deletion ofimages on modalities, workstations, etc.Avoids accidental deletion of images onmodalities and workstationsIHE Integration ProfileSCHEDULED WORKFLOW56IHE – Europe WorkshopAachen – 27 January 2002

Storage Commit. - Push ModelModality orImageCreatorC-STORE operations ….N-ACTION - (list of referenced image UIDs)N-EVENT-REPORT - (success or failure)ImageManager• Images (or objects) are pushed to storage device• N-ACTION provides a list of UIDs for objects to be reliablystored (may be different AE than storage)• N-EVENT-REPORT confirmation from Storage to Modality• Implementations must design for transactions being onmultiple associations• When N-EVENT-REPORT is sent by Storage Device isproduct dependent and may be hours after N-ACTIONIHE Integration ProfileSCHEDULED WORKFLOW57IHE – Europe WorkshopAachen – 27 January 2002

Image Availability QueryIHE Integration ProfileSCHEDULED WORKFLOW58IHE – Europe WorkshopAachen – 27 January 2002

Image Availability Query Actors and TransactionImage DisplayImage CreatorDepartmentSystem Scheduler/ Order FillerImageManagerImageArchive11ImageAvailability QueryPerformedProcedure StepManagerAcquisitionModalityIHE Integration ProfileSCHEDULED WORKFLOW59IHE – Europe WorkshopAachen – 27 January 2002

Image Availability Query• Allows DSS to know when acquired imageshave reached Image Archive and are readyto be interpreted• Minimizes delays in workflow• MPPS does not guarantee that images weresent to the Archive or will ever be• No notification mechanism in DICOM• Specialized Query (C-FIND) is definedIHE Integration ProfileSCHEDULED WORKFLOW60IHE – Europe WorkshopAachen – 27 January 2002

Image Availability QueryDSS/Order FillerC-FIND-RQ (with matching keys)C-FIND-RSP (matches with return keys)ImageManager• Instance UID returned in the query responsesignifies availability.• Storage Location - a system that is a holder ofimages at a particular period in time (AE Title).• Instance Availability - a period of time for images tobe moved from a storage location to be ready fordistribution (OFFLINE,NEARLINE, ONLINEIHE Integration ProfileSCHEDULED WORKFLOW61IHE – Europe WorkshopAachen – 27 January 2002

Image Query/RetrieveIHE Integration ProfileSCHEDULED WORKFLOW62IHE – Europe WorkshopAachen – 27 January 2002

Query/Retrieve Actors and TransactionImage DisplayImage CreatorQueryImages14DepartmentSystem Scheduler/ Order FillerSystem DatabaseImageManagerRetrieveImages16ImageArchivePerformedProcedure StepManagerAcquisitionModalityIHE Integration ProfileSCHEDULED WORKFLOW63IHE – Europe WorkshopAachen – 27 January 2002

Query Retrieve of ImagesImageDisplayC-FIND-RQ (with matching and return keys)C-FIND-RSP (matches with return keys)ImageArchive• Defines Matching keys for response filtering byImage Archive• Defines Return keys to be requested by ImageDisplay• Defines Returned attributes by Image Archivein query responses• Defines Returned attributes required to be displayedon Image DisplayIHE Integration ProfileSCHEDULED WORKFLOW64IHE – Europe WorkshopAachen – 27 January 2002

Study LevelAttributes NameTagIHE Integration ProfileSCHEDULED WORKFLOWQuery Keys Matching65Query Keys ReturnSCU SCP SCU SCPStudy Date (0008,0020) R+ R R+ RStudy Time (0008,0030) R+ R R+ RAccession Number (0008,0050) R+ R R+ RPatient Name (0010,0010) R+ R R+ RPatient ID (0010,0020) R+ R R+ RStudy ID (0020,0010) R+ R R+ RStudy Instance UID (0020,000D) R+ R O RModalities 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 LevelModality (0008,0060) R+ R R+ RSeries Number (0020,0011) R+ R R+ RSeries Instance UID (0020,000E) R+ R O RNumber of Series Related Instances (0020,1209) N/A N/A O RRequest 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 LevelInstance Number (0020,0013) R R O RSOP Instance UID (0008,0018) R+ R O RSOP Class UID (0008,0016) O R O R+RIHE GenericKeys for QueryRetrieve of:- Images- GSPS- SR= Required by DICOMR+ = IHE-2 Requirementto be displayed orentered (SCU),to be returned(SCP)IHE – Europe WorkshopAachen – 27 January 2002

Image Specific Query Matching andReturn KeysAttribute Name Tag Query Keys Matching Query Keys ReturnSCU SCP SCU SCPImage Specific LevelRows (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+IHE Integration ProfileSCHEDULED WORKFLOW66IHE – Europe WorkshopAachen – 27 January 2002

References:Questions ?IHE Europe: http://www.IHE-Europe.orgIHE France: http://www.gmsih.fr/fr/IHEIHE Germany: http://www.IHE-D.orgIHE Italy: http://www.rad.unipd.it/IHEIHE UK:http://www.IHE-UK.orgIHE North America: http://www.rsna.org/IHEIHE Integration ProfileSCHEDULED WORKFLOW67IHE – Europe WorkshopAachen – 27 January 2002