Rad Tech Minutes 08.07.15

Attendees

• Ruth Berge, GE
• Christoph Dickmann, Siemens
• Dick Donker, Philips
• Dave Heaney, McKesson
• Mike Henderson, Eastern Informatics
• Chris Lindop, GE
• Paul Seifert, Agfa
• Chris Carr, RSNA

Minutes

Scheduled Worflow II: Reviewed the open issues in Chris Lindop's draft document with comments from Christoph Dickmann to expand discussion in preparation for creating revised version of profile.

Review of Open Issues

• Radiology Acquisition Workflow may be a better name for a new profile than SWF II

1. Image Manager/Image Archive Actor Grouping

• In practical terms, the current framework defines interactions with the Image Manager (even Q/R should go through the Image Manager so it can update the demographics as needed). It is left as a task for the Image Manager vendor to either embed an Image Archive in the Image Manager, or if they want to use a separate box as the Image Archive, they handle that integration themself.
  • One could argue we should simply remove the Image Archive actor from the profile, or make it a dashed-line actor to more clearly indicate we really don't address it.
• Extracting the Image Archive would require defining the interface by which the Image Manager drives the Image Archive.
  • Transactions between Image Manager and Image Archive might be extensions of current DICOM transactions or non-DICOM (eg, HL7 or SQL)
  • They would have to address deletion of data
  • Our current approach of having the Image Manager handle PIR might require prohibiting the Image Archive from interacting directly with clients which might be a problem

• Use Cases for Breaking Out the Image Archive:

1. "Plug and play" interoperability so sites could choose/replace the Image Archive independant of the Image Manager

2. Replacement of Image Manager while avoiding migration/replacement of Archive

3. Use a General Purpose archive that could store reports and other medical documents as well as images (e.g. XDS Repository, Enterprise Datastore, etc)

4. Access multiple Federated Archives from a single Image Manager (The Multi-Source option was a bit of a kludge).

• Federated Image Managers doens't really make sense. One manages departmental workflow. Different departments federate via the Order Placer/Order Filler level.

5. Distance reading: single archive shared by multiple image managers

2. Define grouping and roles of Department System Scheduler and Order Filler

• The DSS/Order Filler is really just an Order Filler. It manages a worklist. It records when things get done. There are attributes in the worklist for date/time/equipment but IHE mandates very little "scheduling".

• The current mapping to procedure steps is more about "procedure planning" than "scheduling"

• We could introduce a Scheduler actor and think about more sophisticated enterprise scheduling (but that may be more of an ITI piece of work)
• We could introduce a Department Workflow Manager actor to do more sophisticated workflow coordination across acquisition, post-processing and reporting, as described in the whitepaper.
• Currently the text does not include a clear definition of the roles of the DSS and OF actors
• Clarify or remove sections that refer to DSS independently

3. Reconcile ADT transactions with PAM and/or refactor and replace with references to PAM

• Some required transactions in SWF are optional in PAM: possible to add Radiology-specific "extensions" (ie, constraints) to PAM?
• Work through HL7 Task Force to map radiology requirements to PAM; develop appendix to be shared by ITI and Rad TFs describing relationship
• Exclude ADT from Rad AWF
• Probably include Order Placer in Rad AWF
• PAM provides ID management (including merge function) and encounter management
• PAM does not provide order management capabilities

• DSS can get order information directly from ADT for scheduling

• DSS/OF and OP actors would both have to be grouped with Receiver actor to get patient ID, demographics, etc.
• Possible to replace Patient Update transaction to Order Filler (RAD-12)with Patient Demographic Query transactions?

• PAM messages to Order Placer
• Legacy systems won't have PDQ capabilities

• Need to describe how OP and OF reconcile the information provided in order with information provided in PAM
• Identify "source of truth" for each class of data: for registration info, IDs and demographics, probably ADT
• OF has to manage patient ID info during course of task, but not maintain it persistently

• Report Repository and Image Mgr/Archive should have mechanism to update: currently provided by Order Filler in PIR

• Reasons to refactor registration messages and reference PAM: don't diverge from model and benefit from updates made to PAM
• Reference PAM or just lift transactions into Rad AWF?

4. Remove PPS Manager

• Move its functions to Order Filler, which becomes source of info on modality status
• CAD devices' needs have to be considered in working through this change: they also need modality status
• Image Manager currently uses MPPS for group case, PGP
• Require modalities to send information to OF; make other destinations optional
• Closes loop for Modality Worklist

5. Common Personnel Identity

• Modality needs information about tech at console
• Currently only provided unstructured name field in MPPS

• Possible to incorporate Personnel White Pages transactions?
• Get DICOM to add coded value for personnel in MPPS?

• Need to meet differing requirements for personnel identification of large and small sites
• Do not want to require PWP, but rather coordinate with AWF transactions
• Make sure to add "all other attributes" value to MPPS code tables
• Request information from users: What is broken? Does selected approach address it?

6. Remove Options

• Make hard requirements where appropriate
• Basic functionality of profile should be available without options in place; options add supplementary features
• Replace some options with specific conditional requirements

7. Charge Posting

• How to address billing/materials management option in Rad AWF?
• Move the option/condition requirements to Charge Posting profile?
• Examine what information billing systems need to do their work (include MPPS status info?)

8. Fold PIR into Rad AWF

• Leads to bigger issue of how data gets updated with respect to PAM and Enterprise Information Systems
• Need to define how each actor responds to updates

• Next Tcon: Thursday, August 14, 11:30am-1:30pm CDT

Radiology Technical Committee