Reporting Whitepaper - Section 5

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<<Need to review table. There are missing push/pull pairings for some artifacts.>>

I have a Draft Report I need to Push somewhere, so look down the table, see that it's a type of Radiology Report which are encoded in HL7 CDA and you can push with one of two transactions depending on what transport your sender and receiver prefer.

Artifact	Encoding	Transaction	Transport	Dir	Input/Output
Patient Summary	HL7 CDA-MS	???	???	Pull	History/Allergies/Problems/Meds
Order	HL7 ORM	Placer Order Management	HL7 2.3.1 Msg	Push	Order
		(Placer Order Management)	HL7 2.5 Msg	Push	Order
Worklist	DICOM MWL IOD	Modality Worklist Provided	DICOM MWM C-Find	Pull	Acquisition Worklist
	DICOM UPS IOD	(Query Worklist)	DICOM UPS C-Find	Pull	Post-Proc Worklist Reading Worklist Overread Worklist Verification Worklist
		(Push Workitem)	DICOM UPS N-Create	Push	Overread Worklist Verification Worklist
Images	DICOM Image IODs	Images Stored	DICOM C-Store	Push	Acquired Images Processed Images 3D Views
		Retrieve Images	DICOM C-Store	Pull	Acquired Images Processed Images 3D Views
Performed Proc.	DICOM MPPS IOD	Modality Procedure Performed	DICOM N-Set	Push	Acquisition
	DICOM UPS IOD	(D-Store Performed Proc)	DICOM UPS N-Get	Pull
	HL7 DFT?	(H-Store Performed Proc)	(HL7 Msg)	Push	???
Radiation Dose	DICOM SR Dose IOD	(Store Dose)	DICOM C-Store	Push	Acquisition Dose
Procedure Log	DICOM SR PLog IOD	(Store Procedure Log)	DICOM C-Store	Push
Audio	???	(Store Audio)	???	Push	Dictation
Radiology Report	HL7 CDA	(D-Store Report)	DICOM C-Store	Push	Proto Report Draft Report Overread Report Signed Report
		(H-Store Report)	HL7 2.5 MDM Msg	Push	Draft Report Signed Report
Lab Results	HL7 CDA	(H-Retrieve Report)	HL7 2.5 QRY Msg	Pull
Path Results	HL7 CDA	(H-Retrieve Report)	HL7 2.5 QRY Msg	Pull
Staff Schedule	HL7 ???	Out of scope?	???	????	Staff Schedule
Staff Details	HL7 ???	<PWP>	???	Pull	Certifications

May later want to add the XDS transactions for artifacts that are conveyed between enterprises.

HL7 Pull - 2.3/2.5 Query, but there is no standard query (QRY) with a DOC message response

• If a single result you might get the doc in the response.
• If many results, you'd probably get URLs and use HTTP transport to pull the document you want

Patient History Sheet

Tech Interview Sheet

Bill X12

CDA in Imaging

<Material from Section 3 to go in Section 5>

• Investigate CDA as an authoring and distribution format for diagnostic reports
• Two gaps are:
  • the lack of CDA report templates for a broad set of Radiology reports
  • the lack of deployed implementations using CDA

Push vs Pull

Currently most data transfer transactions are either Push or Pull, not both.

Mostly, the preference is for clients to be in control, so client inputs are Pulled (from Servers) and outputs are Pushed (to Servers). Configuration issues also favour this approach.

When bandwidth limitations cause client response times to be unacceptable to users, this is sometimes addressed by having inputs Pushed (to the client), sometimes at the cost of needing more local storage.

When explicit workflow control is "overkill", implicit workflow is sometimes implemented by having inputs Pushed (to the client). The presence of the input implies that some action should be performed on it.

When the client needs to know promptly when an (infrequently and unpredictably updated) piece of information has been updated, that input may be Pushed (to the client) to avoid excessive polling. When there is also a desire to avoid excessive broadcasts, the data push can be expanded to Publish-Subscribe.

<<Should continue to flesh out the cases where it makes sense to push inputs and pull outputs so we can add such transactions when it's appropriate and not complicate the architecture when it's not>>

<<We should start working out which nodes would prefer to pull it's inputs or have them pushed, and which would like to push it's outputs or have them pulled. It depends somewhat on the overall workflow architecture. Not sure if it goes in Section 3, Section 5, or Section 6.>>