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Integrating the Healthcare Enterprise

Integrating the Healthcare Enterprise. Options of Scheduled Workflow and Charge Posting. Andrei Leontiev Dynamic Imaging IHE Radiology Planning Committee. Scheduled Workflow Options. Multiple options exist in Scheduled Workflow Profile that allow certain degree of workflow “tune-up”

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Integrating the Healthcare Enterprise

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  1. Integrating the Healthcare Enterprise Options of Scheduled Workflow and Charge Posting Andrei Leontiev Dynamic Imaging IHE Radiology Planning Committee IHE Interoperability Workshop

  2. Scheduled Workflow Options • Multiple options exist in Scheduled Workflow Profile that 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 IHE Interoperability Workshop

  3. Scheduled Workflow Options • Assisted Protocol Setting • Gives the Department System Scheduler an option to notify directly control protocol settings on the Modality. • Exception Management • Gives the Modality an option to better handle and provide feedback on discontinued studies, including cases of wrong selections on the worklist. IHE Interoperability Workshop

  4. Scheduled Workflow Options • Departmental Appointment Notification • Gives the Department System Scheduler an option to notify Order Placer of date and time of scheduled examinations. • Instance Availability Notification • Gives the Image Manager an option to notify Order Filler and other workflow management actors of availability status of evidence objects. IHE Interoperability Workshop

  5. Modality Options in SWFTransaction Diagram IHE Interoperability Workshop

  6. Assisted Protocol OptionValue Proposition • Reduce variance on how procedures are performed • Centralize configuration effort • Mechanism • Order Filler/DSS passes Protocol Codes to the Acquisition Modality inside the Modality Worklist Item (DICOM) • Modality configuration is set accordingly either automatically or manually by operator IHE Interoperability Workshop

  7. PPS Exception Management Option • Motivation • Provide better feedback on discontinued studies • Handle selection of wrong worklist item • Mechanism • Provision of Discontinue Reason Code in PPS Completed transaction (DICOM) IHE Interoperability Workshop

  8. Code Meaning (0008,0104) Discontinue Reason Codes 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 IHE Interoperability Workshop

  9. Appointment NotificationAbstract / Scope • Existing Placer Order Management Transaction allows Order Placer specify preferred date and time of an order fulfillment (i.e., radiological examination) • Order Filler is ultimately responsible for scheduling of examination as a succession of Procedure Steps that may require one or more appointments to be created • Currently, Order Placer has no way to know when or where exactly the appointment will take place. IHE Interoperability Workshop

  10. Appointment NotificationValue Proposition • 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 IHE Interoperability Workshop

  11. Appointment NotificationTransaction Diagram IHE Interoperability Workshop

  12. Appointment Notification Transaction • Department System Scheduler/Order Filler generates Appointment Notification messages and sends them to the corresponding Order Placer actor. • Order Placer receives Appointment Notification messages and internally processes them. IHE Interoperability Workshop

  13. Interaction Diagram IHE Interoperability Workshop

  14. Appointment Notification Transaction • Three typical use cases • New booking: initial scheduling of an examination • Re-schedule: change in date/time of examination • Cancellation: examination cancellation • Mechanism • HL7 SIU messages • One message may convey multiple appointments corresponding to a single order • One appointment corresponds to one or more Scheduled Procedure Steps IHE Interoperability Workshop

  15. SIU Message Structure IHE Interoperability Workshop

  16. SCH Segment • Specifies common information for one or more appointments associated with single order • Placer Appointment ID is not used • Filler Appointment ID is required • Appointment timing is defined on the Resource Group level, per Scheduled Procedure Step • SCH-6 has fixed value of 1 • One message can have multiple resource groups, thus multiple appointments (procedure steps) • No patient identification information is required, thus Order Numbers are required IHE Interoperability Workshop

  17. AIS Segment • Specifies Procedure Code and Description to for the Scheduled Procedure Step(s) included into this appointment • Procedure Code in components 1-3 • Not all steps of the procedure may be included • Those included are identified by a the text in component 5 • Date/Time of an appointment is expected to be in UTC • If local, UTC offset is required • No specification of location or resources (one should use AIG, AIL, AIP segments within the same group, as appropriate) IHE Interoperability Workshop

  18. What is not in the option • 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 IHE Interoperability Workshop

  19. Instance Availability NotificationAbstract / Scope • DSS/Order Filler, Post-Processing Manager, Report Manager need to know when acquired evidence objects made it to the Archive • MPPS may be sent before objects are stored, and storage may fail • MPPS is not available to all “managers” • MPPS may fail or not be sent at all (media import) • Existing query mechanism forces “managers” to poll Image Manager/Archive for availability of SOP Instances. IHE Interoperability Workshop

  20. Instance Availability NotificationValue Proposition • Enhances mechanism that allows to obtain information about availability of newly-acquired images and other evidence objects, for further use in workflow • Provides this information to all workflow management actors IHE Interoperability Workshop

  21. Instance Availability Notification Transaction IHE Interoperability Workshop

  22. Use Cases • 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 IHE Interoperability Workshop

  23. Instance Availability Notification Transaction • 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. IHE Interoperability Workshop

  24. Instance Availability Notification SOP Class • New SOP Class introduced in DICOM Supplement 93 • Normalized Service • N-CREATE Operation only • Can be used without association with MPPS • Does not convey and explicitly forbids adding of patient or procedure identifiers • Provides list of all object UIDs and their availability for retrieval, either over network or media (on per-image basis) IHE Interoperability Workshop

  25. Instance Availability Notification SOP Class • New SOP Class introduced in DICOM Supplement 93 • No requirements when to generate notifications, for example: • availability of the first instance of a Performed Procedure Step or Study upon its reception, • availability of an entire set of instances comprising a completed Performed Procedure Step or Study Can be used without association with MPPS • Is not intended to satisfy scenarios or erroneous information reconciliation (see PIR profile) IHE Interoperability Workshop

  26. Instance Availability Values • “ONLINE” means 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” means 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 • “OFFLINE” means that a 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” means 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. IHE Interoperability Workshop

  27. Trigger Events • 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 • Image Manager shall send IAN to DSS/OF, and optionally to other actors IHE Interoperability Workshop

  28. Message Semantics • 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 IHE Interoperability Workshop

  29. Expected Actions • 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 add items to a corresponding worklist. IHE Interoperability Workshop

  30. References • Profile Option - Volume 1, Chapter 3 • Transactions - Volume 3, Section 4.49 IHE Interoperability Workshop

  31. Charge PostingAbstract / Scope • 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 IHE Interoperability Workshop

  32. Charge PostingValue Proposition • 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. IHE Interoperability Workshop

  33. Profile NameTransaction Diagram IHE Interoperability Workshop

  34. Charge PostingStandards Used • 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.) IHE Interoperability Workshop

  35. Charge PostingActors • ADT Patient Registration • Order Filler/Department System Scheduler • Charge Processor • Acquisition Modality IHE Interoperability Workshop

  36. 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

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