Appointment Workflow - Brief Proposal

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1. Proposed Profile: Appointment Workflow

  • Proposal Editor: Christophe Trébuchet(CH Sud Réunion) / (Karima Bourquard (GMSIH)
  • Date: N/A (Wiki keeps history)
  • Version: N/A (Wiki keeps history)
  • Domain: ITI/GMSIH and CH Sud Réunion

2. The Problem

In hospitals, the centralized appointment solutions are more and more frequently implemented and used. They are interfaced with care management solutions, EMR or with the patient agendas and resources. Because of the lack of a good integration between centralized appointment solutions and RIS or any others healthcare solutions, several problems will be occured: - collusion between radiology appointment with others appointments ; - no possibility to take appointments in radiology following or preceding others appointments in other specialties ; - no possibility to take a radiology appointment with the attendance of a non radiologist resource ; - no possibility to consult radiology appointments inside the care management.


3. Key Use Case

An easy answer to solve this problem is possible today because of the improvement of the management of the resources inside of the most common centralized appointment management solutions. The management of the radiology resources , appointments and agendas will be done in the centralized solution. Then it is necessary to create a workflow between the RIS and the centralized appointment solution for each appointment with the given data : date, hour, room, act, radiologist, devices. The RIS will register as usual the patient when patient arrives in radiology department and the rest of the procedures is the same. The workflow between RIS and the EMR will be the same that already described in the radiology workflow (feedback from radiology department : radiology report, state of the appointment,…). This answer can give the possibility to hospitals to use a unique centralized appointment solution. It can be also used by any solution in a ward department using a specific appointment management solution.


4. Standards & Systems

  The general workflow will be the following :



Schema : see document




Actors 
Appointment Requester (AR)
this system requests for placing a new appointment for a patient according to the others constraints
Appointment Filler (AF)
this system, after managing the requests and validation by the appointment requester, sends to the appointment tracker all the datas of the new appointment for the patient
Appointment Tracker (AT)
after receiving the appointment, permits to the user to consult a particular or a list of appointment for one or several patients. It also publishes the status of the appointment given by the Order Placer (in the ward) or the Order Filler in the others departments.

The standards which could be used are HL7V2.5 or V3

5. Discussion

this kind of profile is under the competency of IHE. This problem was discussed between memebers of IHE few years ago with no answer. Because of the maturity of the domain and memebers in IHE, I am confident that it is now possible to solve it in ITI domain. The reason is that the appointment is a transversal function in the Hospital IT.

Inpatient Imaging Workflow Problems describes some related problems in Radiology.

Comments

Kboone 14:04, 6 September 2007 (CDT)

It isn't clear whether this is an IT Infrastructure profile, or a Patient Care Coordination profile. I am not personally adverse to it being in either domain, but would suggest that the PCC and ITI Planning committees have a discussion about what the appropriate boundaries are. See the descriptions of both domains below:

The IT Infrastructure Domain supports profiles which supply the necessary infrastructure for sharing healthcare information. An infrastructure interoperability component represents a common IT function that is used as a building block for a variety of use cases... a necessary ingredient, but rarely visible to the end user!! These components may be imbedded in an application, but are often deployed as a shared resource within a RHIO or Health Information Exchange.

IHE Patient Care Coordination (PCC) domain was established in July 2005 to deal with integration issues that cross providers, patient problems or time. It deals with general clinical care aspects such as document exchange, order processing, and coordination with other specialty domains. PCC also addresses workflows that are common to multiple specialty areas and the integration needs of specialty areas that do not have a separate domain within IHE.

Kboone 14:16, 6 September 2007 (CDT)

The Appointment Tracker overlaps with the Professional Services Data Repository actor, which may return prior and future appointments. However, that profile does not presently support queries by provider or resource or queries for more than one patient. We would like to ensure that this proposal going forward is coordinated with QED.