Encounter Based Imaging Workflow - Proposal

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1. Proposed Workitem: Encounter-Based Imaging Workflow (EBIW)

  • Proposal Editor: Kevin O'Donnell
  • Proposal Contributors: Elliot Silver, Christopher Roth, Dawn Cram, ...
  • Editor: TBA
  • Contributors: TBA
  • Domain: Radiology

2. The Problem

Encounter-based Imaging is presented here as an alternative to Order-based Imaging (aka Scheduled Workflow).

To draft SWF, the committee did a rather involved analysis including:

  • Use Cases - what are the different ways order-based imaging is performed
  • Metadata - what context details need to be captured, stored, conveyed
  • Linkage - what other artifacts do the images need to be linked to, and how
  • Organization - how is the data organized to meet the needs of its users
  • Communication - what notifications and "loop-closures" are needed
  • Data Transfer - what protocols should be used for the different artifacts

Encounter-based Imaging is a burgeoning area of activity, but a similar cross-vendor exercise has not been done.

At the time (late 90's), even with many vendors converging on similar concepts, the SWF exercise was valuable in teasing out subtle details, resolving elements of disagreement and confusion in the implementer community, and nailing down various technical details. It contributed to an extended period of robust departmental interoperability.

An EBI exercise and profile could provide similar benefits in the expanded medical imaging community. It might also avoid silo-ization of the medical imaging record.

Sites have highlighted EBI related problems like:

  • Images Absent from or Scattered throughout EHR
  • Images Not Available to Care Team
  • Images Placed in Paper Record or Scanned into EHR
  • Limited Access to Images within EHR Context
  • Limited Data Sharing w/ Acquired & Affiliated Hospitals

3. Key Use Case

<Describe a short use case scenario from the user perspective. The use case should demonstrate the integration/workflow problem.>

<Feel free to add a second use case scenario demonstrating how it “should” work. Try to indicate the people/systems, the tasks they are doing, the information they need, and hopefully where the information should come from.>

EBI Examples:

  • Dermatology
  • Wound Care/Management
  • Infectious Diseases
  • Burn Care
  • Ophthalmology
  • Otolaryngology
  • Plastic Surgery
  • Podiatry
  • ER/Trauma
  • Dentistry
  • Sports Medicine
  • Pathology Samples
  • Point of Care Ultrasound
  • Nursing/Clinic Photography
  • Procedure (Surgery?) Video
  • The video isn't ordered. Does Surgery fit the encounter model well?
  • Sleep Lab Video
  • More likely to be ordered?

4. Standards and Systems

Potential Systems

  • Image Acquisition Devices (both Lightweight and Heavy/Integrated)
  • Image Archiving Devices
  • Electronic Medical Record Systems
  • Patient Management Systems?

Potential Standards

  • Existing Profiles: PAM, WIC, SWF, MHD-I, XDS*, CARD IEO
  • DICOMweb
  • HL7
  • FHIR
  • Consumer formats: JPEG, MPEG, PDF, etc

5. Discussion

More analysis here: Order-based vs Encounter-based Imaging - JDI Whitepaper
Technical approach thoughts
Perhaps new EBIW profile that parallels SWF
Perhaps expand WIC?
Consider focusing primarily/exclusively on FHIR and DICOMweb?
This goes beyond the definition of Radiology, however RAD profiles have provided a basis for other imaging domains
RAD is the closest thing IHE has to a general Medical Imaging domain
Have TC members who understand the solution technologies well
Need contributors who understand the use cases well
Would be advisable to solicit collaborators from Cardiology, Eyecare, and perhaps ITI
SIIM-HIMSS Enterprise Imaging Workgroup - White Papers
Should the scope include "self-captured" data from patients at home or remote?
Continue to delineate EBI vs Enterprise Imaging vs mobile vs consumer vs lightweight vs web APIs vs ...
Consider categorization into Diagnostic Imaging, Procedural Imaging, and Evidence Imaging (document current patient state)
A Foundation for Enterprise Imaging - JDI Whitepaper

See Also