IHE Radiology Integration Profiles: ▪ Post-Processing Workflow ▪ Reporting Workflow

1. IHE Radiology Integration Profiles: ▪ Post-Processing Workflow ▪ Reporting Workflow IHE Educational Workshop – June 11-13, 2007 Nikolaus Wirsz, PhD Manager IT Standards / Siemens Medical Solutions IHE Radiology Planning Committee

2. IHE Radiology Integration Profiles Billing Workflows Post-Processing Workflow Teaching Files & Clinical Trials Export Manage worklists, track status, perform & notify image processing & CAD steps Standardize Clinical Trial Data and Anonymization Teaching/Research Contents & Display Common Infrastructure Reporting Workflow Manage worklists, track status, perform & notify diagnostic reporting steps NM Image Create, store, manage, retrieve & use NM image objects Charge Posting Scheduled Workflow Admit, Order, Schedule Patient Information Reconciliation Collect and post timely billable procedure details Manage worklists, track status, perform & notify acquisition related step, Presentation of Grouped Procs Manage individual procedure image subsets from a multi-procedure acquisition for viewing & reporting Reconcile worklists, status, and data objects for unknown patients and demographics changes create, store, manage, retrieve & use images Consistent Presentation of Images Simple Image and Numeric Reports Evidence Documents Key Image Notes Manage, retrieve & use objects to record study evidence Create, store, manage, retrieve & use objects to flag significant images Manage simple diagnostic reports with optional images, measurements Manage, retrieve & use objects for hardcopy and softcopy grayscale presentation states XDS for Imaging - Sharing of Imaging Information across health enterprises Access to Radiology Information -Consistent access to images and reports Portable Data for Imaging - Consistent access to images and reports on CD Media ITIATNA – Radiology Option (Replaces Basic Security)

3. IHE Radiology Integration Profiles Billing Workflows PPWF RWF Post-Processing Workflow Teaching Files & Clinical Trials Export Manage worklists, track status, perform & notify image processing & CAD steps Standardize Clinical Trial Data and Anonymization Teaching/Research Contents & Display Common Infrastructure Reporting Workflow Manage worklists, track status, perform & notify diagnostic reporting steps NM Image Create, store, manage, retrieve & use NM image objects Charge Posting Scheduled Workflow Admit, Order, Schedule Patient Information Reconciliation Collect and post timely billable procedure details Manage worklists, track status, perform & notify acquisition related step, Presentation of Grouped Procs Manage individual procedure image subsets from a multi-procedure acquisition for viewing & reporting Reconcile worklists, status, and data objects for unknown patients and demographics changes create, store, manage, retrieve & use images Consistent Presentation of Images Simple Image and Numeric Reports Evidence Documents Key Image Notes Manage, retrieve & use objects to record study evidence Create, store, manage, retrieve & use objects to flag significant images Manage simple diagnostic reports with optional images, measurements Manage, retrieve & use objects for hardcopy and softcopy grayscale presentation states XDS for Imaging - Sharing of Imaging Information across health enterprises Access to Radiology Information -Consistent access to images and reports Portable Data for Imaging - Consistent access to images and reports on CD Media ITIATNA – Radiology Option (Replaces Basic Security)

4. Reporting Workflow (RWF) – Summary • Extension to the Scheduled Workflow toSupport Typical Reporting Workflow Tasks: • Interpretation • Dictation • Transcription • Verification • Review • Comparison • Ability to Schedule and Track the Status of Reporting Tasks

5. Reporting Workflow (RWF) – Overview Work Item Claimed Released (Completed) Reporting Worklist Store Reports Reporting Procedure Step STARTED Measurements CAD Reports ………………… Retrieve Images &Evidence Documents Reporting Procedure Step STARTED RIS Report Manager Report Reader/Creator Reporting Procedure Step COMPLETED PACS & Archive Image Manager/ Archive Reporting Procedure Step COMPLETED

6. RWF – Actors & Transactions • Reporting Actors: • Reporting Manager • Report Creator / Report Reader • Report Repository • Transactions: • Reporting Worklist Provided • Work Item Claimed • Work Item PPS In Progress • Work Item PPS Completed • Work Item Completed • Performed Work Status Update • Retrieve Images / Evidence Documents • Submit / Retrieve / Issue Reports

7. RWF – Report Manager Grouping Report Manager DSS/OF Performed Work Status Update (optional) IM/IA Report Manager IM/IA Performed Work Status Update DSS/OF • Report Manager NOT Grouped DSS/OF Report Manager IM/IA • Report Manager Grouped with Image Manager • Report Manager Grouped with DSS/OF

8. RWF – Actors & Transactions Retrieve Images Retrieve Evidence Documents Report Submission Reporting Worklist Provided Images Available Work Item Claimed Performed Work Status Update Work Item PPS In Progress Work Item PPS Completed Work Item Completed IM/IA Image Display Report Manager Report Creator/ Report Reader DSS/OF

9. Reporting Workflow – Value Proposition • Improve Reporting Workflow Efficiency –Use of Worklists to Manage Reporting Tasks • Eliminate Errors Associated with Paper and Film Handling • Close the Information Loop - Proper Association of Reports with: • Corresponding Order • Acquired Images • Other Clinical Evidence • Enable direct access to images and evidence documentsto be interpreted • Enable access to prior reports and old images

10. Post-Processing Workflow (PPWF) – Summary • Extension to the Scheduled Workflow to SupportTypical Post-Processing Workflow Tasks: • Image Processing • Image Reconstruction • Computer Aided Detection • 3D View Generation • Quality Control • Ability to Schedule and Track the Status of Post-Processing Tasks

11. Post-Processing Workflow (PPWF) – Overview RIS Work Item Claimed Departmental System Scheduler Order Filler Completed Post-ProcessingWorklist Post-Processing Procedure Step STARTED RetrieveImages Store Reports Measurements CAD Reports ……....……… Archive Images Post-Processing Procedure Step STARTED 3D Workstation PACS & Archive Image & Post-Proc. Manager Post-Processing Procedure Step COMPLETED Post-Processing Procedure Step COMPLETED

12. DICOMModality Worklist ScheduledProcedure Step A Report ScheduledProcedure Step B One or more series of images One or more series of images DICOMPost-Processing Worklist M-Perf.Procedure Step P1 PP-Perf.Procedure Step P2 Post-Processing AcquisitionModality Modality and Post-Processing Steps Radiology Department ORDER A request for RadiologicalService Set of Codifiable, Billable Acts Requested Procedure 1

13. PPWF – Actors & Transactions • Additional Actor: • Post-Processing Manager • Transactions: • Worklist Provided • Work Item Claimed • Work Item PPS In Progress • Work Item PPS Completed • Work Item Completed • Performed Work Status Update • Evidence Documents Stored • Query Evidence Documents • Retrieve Evidence Documents

14. PPWF – Post-Processing Manager Grouping Performed Work Status Update (optional) DSS/OF Post-Processing Manager • Post-Processing Manager Grouped with Image Manager (PACS) IM/IA • Post-Processing Manager Grouped with Departmental System Scheduler / Order Filler (RIS) Performed Work Status Update IM/IA Post-Processing Manager DSS/OF

15. PPWF – Actors & Transactions Query Images Retrieve Images Query Evidence Documents Retrieve Evidence Documents Evidence Documents Stored Images Stored Storage Commitment Performed Work Status Update Worklist Provided Image Availability Query Work Item Claimed Work Item PPS In Progress Work Item PPS Completed Work Item Completed IM/IA Image Display Evidence Creator Post-Processing Manager DSS/OF

16. Wrap UpPost-Processing Workflow (Multiple Steps)with Post-Processing Manager Grouped with Image Manager DICOM PP-PPS DICOM PP-PPS DICOM MPPS DICOM Image Storage DICOM Storage CommitmentDICOM MPPS DICOM Storage & Commitment DICOMPP-WL DICOM Storage & Commitment DICOM MWL DICOMPP-SPS DICOMQ/R DICOMPP-SPS DICOMQ/R DICOMPP-WL DICOM PP-PPS DICOMPP-PPS PACS RIS Modality Post-ProcessingStation CAD Station

17. Post-Processing Workflow – Value Proposition • Improve Post-Processing Workflow Efficiency –Use of Worklists to Manage Post-Processing Tasks • Eliminate Errors Associated with Paper and Film Handling • Close the Information Loop: • Integrating Post-Processing Results with Acquired Images • Associate Post-Processing Results with Correct Order • Enable Sub-sequent Workflow Steps: • Initiate Reporting Workflow • Support for Billing Based on Post-Processing Results

18. IHE Radiology Integration Profiles Billing Workflows PPWF RWF Post-Processing Workflow Teaching Files & Clinical Trials Export Manage worklists, track status, perform & notify image processing & CAD steps Standardize Clinical Trial Data and Anonymization Teaching/Research Contents & Display Common Infrastructure Reporting Workflow Manage worklists, track status, perform & notify diagnostic reporting steps NM Image Create, store, manage, retrieve & use NM image objects Charge Posting Scheduled Workflow Admit, Order, Schedule Patient Information Reconciliation Collect and post timely billable procedure details Manage worklists, track status, perform & notify acquisition related step, Presentation of Grouped Procs Manage individual procedure image subsets from a multi-procedure acquisition for viewing & reporting Reconcile worklists, status, and data objects for unknown patients and demographics changes create, store, manage, retrieve & use images Consistent Presentation of Images Simple Image and Numeric Reports Evidence Documents Key Image Notes Manage, retrieve & use objects to record study evidence Create, store, manage, retrieve & use objects to flag significant images Manage simple diagnostic reports with optional images, measurements Manage, retrieve & use objects for hardcopy and softcopy grayscale presentation states XDS for Imaging - Sharing of Imaging Information across health enterprises Access to Radiology Information -Consistent access to images and reports Portable Data for Imaging - Consistent access to images and reports on CD Media ITIATNA – Radiology Option (Replaces Basic Security)