View source for Contrast ordering, management and administration - Administration - Proposal

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The use of contrasts, devices and other consumables is common in Radiology. Concerning information exchange, this can pose two types of questions: there is usually the need for supply and inventory management which includes the maintenance of appropriate inventory, including the matters of traceability and billing of those consumables. 
There is also the matter of tracking of substance administration, since the use of contrast is also relevant to the patient’s care plans. 

These two areas should be covered with enterprise-wide interoperability - beyond the radiology department. This is valid not only for contrasts but expectedly also for medication administered during a procedure, radiopharmaceuticals, or consumables. 

This work item should elicit the needs for supporting the cross-domain work. 
The outcome of this could be a collection of use cases, best practices and other material, leading to cross-domain profile work.


==1. Proposed Workitem: Contrast administration ==

* Proposal Editor: Jose Costa Teixeira
* Editor: ''<Name of candidate Lead Editor for the Profile, if known>'' 
* Date:    N/A (Wiki keeps history)
* Version: N/A (Wiki keeps history)
* Domain: Radiology, Pharmacy 
[[Category:DomainAbbreviation]]

==2. The Problem==

The information contained in Radiology systems about contrast use may be a very basic statement “contrasted procedure”, or detailed, structured information about what contrast product was used, total dose, etc.
The information on the contrast may be of use outside the scope of the specific procedure (for operational or clinical reasons). However, there are no standard ways to interchange this information.

For the procedure itself, it may not be most important to explicit the details of the contrast use, but, the information on contrast use is relevant for at least 2 aspects: 
1. Capturing the use of contrast for tracking consumptions. This is not the same as inventory management: the amount of contrast consumed is not the same as contrast administered. In order to quantify contrast waste, it is important to quantify not only what was consumed but also what was effectively administered.

2. Tracing the contrasts and other products administered to the patients for medication safety, etc.
Enabling a standard interoperability mechanism will allow radiology systems to communicate with all downstream systems in a consistent manner, regardless if this information is used for operational or clinical purposes.


==3. Key Use Case: Tracking of contrast use==

A specialist in a hospital orders a procedure for a patient. The radiologist receiving the order decides that the procedure should be with contrast.

When preparing a contrasted procedure, the radiology technician registers the use of a contrast vial by scanning the barcode in a 20 ml vial. 
Upon scanning the barcode, the system gets information about the type and name of the product, its expiry date and lot number. 
If the contrast was expired, the system would alert to this fact. 

Since there is no alert, the technician puts the contrast into the infusion pump. This pump then administers the contrast synchronously to the modality. 
During the procedure, the patient experiences some difficulties breathing, which slightly complicates the image acquisition.

At the end of the procedure, the infusion pump reports the total amount of contrast used: equivalent to 14 mg. Optionally, it can also inform of the use of saline with the same mechanisms.

The contrast in the pump is not reused for the next procedure. The radiology department then reports to the pharmacy the consumption of a 20 ml vial, and the effectively used contrast. 

The Pharmacy registers the consumption of another vial of 20 ml. This may later be used for determining a resupply or an internal billing.

When the patient goes back to the specialist, the images acquired are not of perfect quality. 

The specialist would prefer a second scan, but also observes that the patient has a renal insufficiency. Since the patient record now shows that contrast was administered and a medication dosage alert suggests that another contrast administration would worsen the patient’s condition, the specialist accepts the current image or requests another scan on a different modality without contrast.


==4. Standards and Systems==

* IHE Pharmacy is working on capturing information of substance administration, for facilitating supply and capturing patient history and medication traceability.
* DICOM is working on SUP 164 for reporting contrast use in a procedure.


==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?>''