Import Reconciliation Workflow Enhancement - Brief Proposal
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1. Proposed Workitem: Import Reconciliation Workflow Enhancement
- Proposal Editor: Peter Kuzmak
- Editor: <Name of candidate Lead Editor for the Profile, if known>
- Domain: Radiology
2. The Problem
A patient has an imaging study performed at one facility and has the study exported to portable media. Later, the patient takes the media to a different institution. The study on that media may need to be imported into that new institution’s imaging system. This would be done to avoid a repeat examination, or so that the study can be on file for reference purposes.
Importing prior studies is best performed by creating a new order on the institution’s imaging system and then associating the DICOM objects from the prior study with it. In this way the prior study is actually inserted into the imaging system’s electronic health record (EHR) and is properly indexed so that it can be identified and later retrieved as needed.
Currently, importing prior DICOM studies into the institution’s systems is a very slow labor intensive process. Processing a single study this way takes anywhere from 10 to 30 minutes (estimate from Department of Veterans Affairs). This is a rather overwhelming task, given the volume of studies that need to be imported. The result is that the prior studies are often not imported and examinations are unnecessarily repeated.
The process to import prior DICOM studies can be automated to eliminate many of the manual steps. Since the automated process is much more efficient for the user, prior studies are more likely to be imported. This means that repeat examinations can be avoided and prior studies are on file for reference purposes.
A DICOM importer using the automated process was deployed nation-wide at the Department of Veterans Affairs in September 2010. One of our users recently reported the following about the new application: "The new process is fantastic... Not manpower intensive or laborious. We can import 80+ radiology studies in less than 2 hours... the old process we had would be at least 15-18 hours for that many studies."
3. Key Use Case
The classic problem is how to deal with the prior study that was performed while the patient was being treated at another facility. The patient brings the CD containing the prior study when the patient went to the local institution for treatment. The patient’s clinician (provider) determined that the outside images/studies are clinically significant and need to be included in the patient’s EHR as reference images. The solution involves importing an outside study that is unknown to the local system.
Importing prior studies is performed by creating a new order on the institution’s imaging system and then associating the DICOM objects from the prior study with it.
Currently, the user loads the media into the drive and then waits for the commercial importer product to read all the DICOM files. The user then has to work on one study at a time. First, the user has to review the study on the commercial importer. The user then has to go to the institution’s RIS and place an order for an equivalent radiology study. Then, the user would has to go back to the commercial importer and use DICOM Modality Worklist to retrieve the order, have the commercial importer update the DICOM images with the institution’s patient and order information, and have them sent to the institution’s imaging system. Finally, the user has to go back to the institution’s RIS to update the study status to indicate that it is completed. The user has to repeat this effort for each study on the portable media that needs to be imported.
The process to import prior DICOM studies can be automated to eliminate many of the manual steps.
The workflow of the import process can be designed to operate like an online merchandise ordering application where the user adds items to a shopping cart and then proceeds to checkout.
All of the interactive item selection is done first and then is followed by an automatic database update commit transaction. First the HIS/RIS patient and equivalent radiology procedure are manually identified for each prior study. Then the DICOM importer process automatically places the order on the RIS for each the equivalent radiology study, uses the order information for import reconciliation, sends the images to the institution’s imaging system, and then updates the status of the study on the RIS to indicate that it was completed.
4. Standards and Systems
<List existing systems that are/could be involved in the problem/solution.>
<If known, list standards which might be relevant to the solution>
5. Discussion
<Include additional discussion or consider a few details which might be useful for the detailed proposal>
- <Why IHE would be a good venue to solve the problem and what you think IHE should do to solve it.>
- <What might the IHE technical approach be? Existing Actors? New Transactions? Additional Profiles?>
- <What are some of the risks or open issues to be addressed?>
<This is the brief proposal. Try to keep it to 1 or at most 2 pages>