Contrast ordering, management and administration - Supply - Proposal

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 ordering, management and administration – Supply

• 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 and Pharmacy

2. The Problem

While the radiology systems typically contain all the information about a procedure, but the full control of such usage and inventory is typically beyond the scope of many radiology information systems: While radiology systems require (and generate) information about whether a procedure uses contrast media, eventually including details about the contrast used, they may not provide an extended range of functionalities for inventory control, ordering, traceability, etc. Instead, they may rely on external, non-clinical systems to provide these functions. This poses an interoperability challenge.

Value Statement

The objective is to define the mechanisms for interoperability between radiology and other systems concerning the ordering and management of contrast media and other items (e.g. consumables). This control is important to enable the institutions to maintain proper operations. Maintaining appropriate stock levels, identifying expired contrasts or medication. Also financially, the impact is apparent: Financial charges by and to the radiology department are also related to the use of consumables such as contrast. The need from interoperability derives especially because of the complexity behind managing inventory and traceability, which is not expected to be fully covered by radiology systems. Formalizing these interoperability mechanisms enables the radiology systems to provide only the basic, procedure-related aspects, leaving the advanced stock management control to specialized systems.

3. Key Use Case: Ordering and stock maintenance of contrast

Part 1 – Ordering In a hospital, the Radiology department notices a low stock count of a contrast and sends an order to the Pharmacy, requesting 50 vials. The Pharmacy sends to Radiology the contrast and the delivery report indicating the delivered items, quantities, expiry dates, lot numbers, etc. The radiology department optionally checks the received items’ barcodes to confirm their arrival. The inventory levels are updated.

Part 2 - Usage When preparing a contrasted procedure, the radiology technician registers the use of a contrast vial by scanning its barcode. The stock position is thus continuously tracked. This provides additional traceability information. As soon as a certain inventory level is reached, the radiology department notifies the supplier or pharmacy by placing another order.

Different variations and use cases can exist and should be supported: - Instead of a pharmacy, the contrast is purchased directly from the vendor - Instead of the radiology department counting the inventory, this can be done by the pharmacy - Items may be not in stock but in consignment and only ordered after consumed. - Control of expired contrast items - ...

4. Standards and Systems

This work impacts Radiology Information Systems.

• Scheduled Workflow
• Charge Posting

• DICOM Substance Administration and Lookup
• DICOM Contrast SR (WIP)

Current work: IHE Pharmacy started a work item on enterprise-wide supply of items, which must support the interoperability needs of the Radiology department.

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?>