Difference between revisions of "Remote Reporting for Imaging (TeleRadiology) - Proposal"
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===Summary=== | ===Summary=== | ||
| − | Cross-Enterprise or Community Diagnostic Image Sharing | + | Cross-Enterprise or Community Diagnostic Image Sharing Services are increasingly part of the infrastructure landscape in the clinical community. Leading the way are IHE profiles and standards, such as XDS-I proving the infrastructure framework for image and document exchange. |
| − | + | Cross-enterprise image sharing, beyond the initial step, has the capability to attain efficiencies and reduce cost at a macro-scale level: | |
| − | Cross-enterprise image sharing, beyond the initial step, has the capability to attain efficiencies and reduce cost at a macro-scale level: | + | * Improve throughput of radiology departments by allowing any qualified radiologist in the community to read and report a study |
| − | + | * Align the number of resources (staff, equipment) with the needs of the community as opposed to considering individual hospitals only | |
| − | + | * Facilitate assignment of studies to physicians that are best qualified to read them (e.g., a SPECT expert may be leveraged across the community) | |
| − | + | * Provide off-hours coverage by sharing radiologists' services off peak hours | |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
==2. The Problem== | ==2. The Problem== | ||
| − | Cross-Enterprise or Community Diagnostic Image Sharing Repositories is a growing service internationally and has proven effective for sharing of previously acquired images and reports. The current IHE XDS-I.b infrastructure effectively supports this. | + | Cross-Enterprise or Community Diagnostic Image Sharing Repositories is a growing service internationally and has proven effective for sharing of previously acquired images and reports. The current IHE XDS-I.b infrastructure effectively supports this. However, ther is a lack of standards for the remote read. Currently, to meet this need, HCIT suppliers have built proprietary systems with non-standard methods for managing this workflow. Proprietary methods limit the solution extensibility. |
Cross-enterprise image sharing, beyond the initial step, has the capability to attain efficiencies and reduce cost at a macro-scale level: | Cross-enterprise image sharing, beyond the initial step, has the capability to attain efficiencies and reduce cost at a macro-scale level: | ||
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The workflow document steps, then, could be: | The workflow document steps, then, could be: | ||
| − | + | The primary use case is workload sharing read. | |
| − | + | ||
| − | + | For a workload sharing example, the specialty read of SPECT images is desacribed: | |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | + | The community hospital has a NM acquisition system fully capable of acquiring SPECT Images, but lacks a credentialed NM Radiographer to read SPECT. Per the institutional business rules, all SPECT images will require a NM credentialed Radiologist to perform the read. The regional image sharing network has NM credentialed Radiologists. Based on the institutional business rules, this study meets the criteria for Remote Read. | |
| − | + | ||
| − | + | The workflow document steps, then, could be: | |
| − | + | # '''Remote Read Request:''' The Remote Read Requester, usually the Radiology department scheduler, has a SPECT study which requires a specialized Radiologist to perform the Read. The Remote Read Requester will collect relevant clinical documents, including the acquired SPECT images, tech notes, clinical summaries, and the original order. The Remote Read Requester will initiate the Remote Read Request specifying the tasks to be performed and the business constraints and provide the request and the document set to the Remote Read Scheduler. The read task locally will be removed from the local worklist. | |
| − | + | # '''Schedule Remote Read:''' Once the Remote Read Scheduler receives the request and document set, the Remote Read Scheduler will evaluate the Remote Read Request and, if it can meet the business constraints, assigns a reader(s) who are NM credentialed Radiologist. The Remote Reade Scheduler will notify the requestor that the request has been accepted and scheduled. The Read task will appear on the remote reader’s worklist. | |
| − | + | # '''Remote Read:''' The Remote Reader's will select the task from their worklist. The Remote Read Requester would be notified that the task is started. The work item may be on their local RIS/PACS or an independent system. The Final Report and any evidence documents are the output of this task. This task may be partitioned into several subtasks to perform the read. A possible set of subtasks could be as described in the IHE Reporting Workflow profile. However, would be considered out-of-scope for this profile. The Final Report is distributed back to the Remote Read Requestor. The worklist item is completed with the Remote Scheduler. | |
| − | + | # '''Read Complete:''' The Remote Read Requester retrieves the Report and completes the Workflow. Billing system is notified(out-of-scope). Final Report distributed to patient's care team(out-of-scope). | |
| − | + | '''Other Considerations''' | |
| − | + | Uses cases for Workload sharing may include: | |
| − | * | + | * Specialty Read(SPECT example) |
| − | + | * Site Loading (time-to-read exceeds threshold example) | |
| − | + | * Off hours coverage | |
| − | + | * Double Read(mammography example) | |
| − | + | * Consult(inconclusive read example) | |
| − | + | * Blind Read(VIP example) | |
| − | + | For Initiating the Remote Read Request | |
| − | + | * The remote read request could be done automatically based on local business rules: | |
| − | *or manually: | + | * all studies acquired after certain time |
| − | + | * carrying certain procedure code (note that unifying procedure codes is out of scope) | |
| − | + | * Include a certain urgency code (codes defined by HL7) | |
| − | + | * Peer review | |
| − | * All Output documents linked via Accession Number and Accession Assigning Authority | + | * Remote Locum read |
| − | * study needs to be removed from local reading list | + | * VIP read (pseudo-anonymous) |
| − | + | * Double Read | |
| − | *Remote Read Workflow shall be extensible to other 'ologies' beyond Radiology | + | * or manually: |
| − | + | * Excessive read workload -for a site | |
| − | *unifying procedure codes across institutions | + | * Specialty Consultant/Second read – directed to a person or specialty pool |
| − | *protocoling | + | Read Request Linkage |
| + | * All Output documents linked via Accession Number and Accession Assigning Authority | ||
| + | * study needs to be removed from local reading list | ||
| + | For Other 'ologies' | ||
| + | * Remote Read Workflow shall be extensible to other 'ologies' beyond Radiology | ||
| + | Specifically out of scope: | ||
| + | * unifying procedure codes across institutions | ||
| + | * Cross institution Imaging Acquisition protocoling, (protocoling performed locally by the Imaging Acquisition Service) | ||
==4. Standards and Systems== | ==4. Standards and Systems== | ||
| Line 109: | Line 101: | ||
**D-SUB can act as a notification mechanism for XDW results available/completed -OR- could be a trigger to receptionist to call Dr. XXX | **D-SUB can act as a notification mechanism for XDW results available/completed -OR- could be a trigger to receptionist to call Dr. XXX | ||
| − | |||
| − | |||
==5. Technical Approach== | ==5. Technical Approach== | ||
===Existing actors=== | ===Existing actors=== | ||
| − | • | + | • See XDW, XDS-I and DSUB |
| − | |||
| − | |||
===New actors=== | ===New actors=== | ||
| − | + | # Remote Read Requester | |
| + | # Remote Read Scheduler | ||
| + | # Remote Read Reader | ||
===Existing transactions=== | ===Existing transactions=== | ||
| − | • | + | • See XDW, XDS-I and DSUB |
===New transactions (standards used)=== | ===New transactions (standards used)=== | ||
| − | + | None | |
| − | |||
| − | |||
| − | |||
| − | |||
===Impact on existing integration profiles=== | ===Impact on existing integration profiles=== | ||
None – New Profiles are proposed. | None – New Profiles are proposed. | ||
===New integration profiles needed=== | ===New integration profiles needed=== | ||
| − | ''' | + | ''' Remote Read Workflow Definition (RRWD):''' A content profile based on the Workflow Definition Template. This content profile captures, in a document, the Imaging Read Workflow definition for remote reading. The document is intended for use by the Cross-Enterprise Document Workflow Integration profile. |
| + | |||
| + | ==6. Support & Resources== | ||
| + | Canada Infoway SCWG-10 has led the development of this proposal and intends to collaborate with IHE on the development of the Remote Read Workflow Definition. | ||
| − | + | PCC has expressed willingness to collaborate with IHE Rad. | |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | + | VA has an extensive remote read need and would be a good candidate for working with on this profile. | |
| − | |||
| − | + | UK, Italy, the Netherlands and other regions within Europe who have deployed XDS, XDS-I and XDW. | |
==7. Risks== | ==7. Risks== | ||
Revision as of 10:27, 2 October 2014
1. Proposed Workitem: Remote Reporting for Imaging (TeleRadiology) Workflow Definition
- Proposal Editor: Chris Lindop on behalf of IHE Canada/Canada Infoway
- 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
Summary
Cross-Enterprise or Community Diagnostic Image Sharing Services are increasingly part of the infrastructure landscape in the clinical community. Leading the way are IHE profiles and standards, such as XDS-I proving the infrastructure framework for image and document exchange. Cross-enterprise image sharing, beyond the initial step, has the capability to attain efficiencies and reduce cost at a macro-scale level:
- Improve throughput of radiology departments by allowing any qualified radiologist in the community to read and report a study
- Align the number of resources (staff, equipment) with the needs of the community as opposed to considering individual hospitals only
- Facilitate assignment of studies to physicians that are best qualified to read them (e.g., a SPECT expert may be leveraged across the community)
- Provide off-hours coverage by sharing radiologists' services off peak hours
2. The Problem
Cross-Enterprise or Community Diagnostic Image Sharing Repositories is a growing service internationally and has proven effective for sharing of previously acquired images and reports. The current IHE XDS-I.b infrastructure effectively supports this. However, ther is a lack of standards for the remote read. Currently, to meet this need, HCIT suppliers have built proprietary systems with non-standard methods for managing this workflow. Proprietary methods limit the solution extensibility.
Cross-enterprise image sharing, beyond the initial step, has the capability to attain efficiencies and reduce cost at a macro-scale level:
- Improve throughput of radiology depts by allowing any radiologist in the community to read and report a study
- Align the number of resources (staff, equipment) with the needs of the community as opposed to considering individual hospitals only
- Facilitate assignment of studies to physicians that are best qualified to read them (e.g., a SPECT expert may be leveraged across the community)
- Provide off-hours coverage by sharing radiologists' services off peak hours
3. Key Use Case
The primary use case is workload sharing read.
For a workload sharing example, the specialty read of SPECT images is desacribed:
The community hospital has a NM acquisition system fully capable of acquiring SPECT Images, but lacks a credentialed NM Radiographer to read SPECT. Per the institutional business rules, all SPECT images will require a NM credentialed Radiologist to perform the read. The regional image sharing network has NM credentialed Radiologists. Based on the institutional business rules, this study meets the criteria for Remote Read.
The workflow document steps, then, could be:
The primary use case is workload sharing read.
For a workload sharing example, the specialty read of SPECT images is desacribed:
The community hospital has a NM acquisition system fully capable of acquiring SPECT Images, but lacks a credentialed NM Radiographer to read SPECT. Per the institutional business rules, all SPECT images will require a NM credentialed Radiologist to perform the read. The regional image sharing network has NM credentialed Radiologists. Based on the institutional business rules, this study meets the criteria for Remote Read.
The workflow document steps, then, could be:
- Remote Read Request: The Remote Read Requester, usually the Radiology department scheduler, has a SPECT study which requires a specialized Radiologist to perform the Read. The Remote Read Requester will collect relevant clinical documents, including the acquired SPECT images, tech notes, clinical summaries, and the original order. The Remote Read Requester will initiate the Remote Read Request specifying the tasks to be performed and the business constraints and provide the request and the document set to the Remote Read Scheduler. The read task locally will be removed from the local worklist.
- Schedule Remote Read: Once the Remote Read Scheduler receives the request and document set, the Remote Read Scheduler will evaluate the Remote Read Request and, if it can meet the business constraints, assigns a reader(s) who are NM credentialed Radiologist. The Remote Reade Scheduler will notify the requestor that the request has been accepted and scheduled. The Read task will appear on the remote reader’s worklist.
- Remote Read: The Remote Reader's will select the task from their worklist. The Remote Read Requester would be notified that the task is started. The work item may be on their local RIS/PACS or an independent system. The Final Report and any evidence documents are the output of this task. This task may be partitioned into several subtasks to perform the read. A possible set of subtasks could be as described in the IHE Reporting Workflow profile. However, would be considered out-of-scope for this profile. The Final Report is distributed back to the Remote Read Requestor. The worklist item is completed with the Remote Scheduler.
- Read Complete: The Remote Read Requester retrieves the Report and completes the Workflow. Billing system is notified(out-of-scope). Final Report distributed to patient's care team(out-of-scope).
Other Considerations
Uses cases for Workload sharing may include:
- Specialty Read(SPECT example)
- Site Loading (time-to-read exceeds threshold example)
- Off hours coverage
- Double Read(mammography example)
- Consult(inconclusive read example)
- Blind Read(VIP example)
For Initiating the Remote Read Request
- The remote read request could be done automatically based on local business rules:
- all studies acquired after certain time
- carrying certain procedure code (note that unifying procedure codes is out of scope)
- Include a certain urgency code (codes defined by HL7)
- Peer review
- Remote Locum read
- VIP read (pseudo-anonymous)
- Double Read
- or manually:
- Excessive read workload -for a site
- Specialty Consultant/Second read – directed to a person or specialty pool
Read Request Linkage
- All Output documents linked via Accession Number and Accession Assigning Authority
- study needs to be removed from local reading list
For Other 'ologies'
- Remote Read Workflow shall be extensible to other 'ologies' beyond Radiology
Specifically out of scope:
- unifying procedure codes across institutions
- Cross institution Imaging Acquisition protocoling, (protocoling performed locally by the Imaging Acquisition Service)
4. Standards and Systems
Systems
- RIS
- PACS
- VNA
- Community Image Sharing Network
Standards
- XDS-I for hosting Images and reports
- XDW underlying workflow profile framework
- Compatible with XDS/XDS-I architecture
- XDW currently does not support Cross community (XCA/XCA-I))
- Workflow is all within the same affinity domain
- This will be addressed in context with IHE ITI community
- XBeR-WD Workflow Definition
- Sufficient for Image Referral
- XDR/XDR-I for point to point
- As necessary
- DSUB for Notifications
- D-SUB can act as a notification mechanism for XDW results available/completed -OR- could be a trigger to receptionist to call Dr. XXX
5. Technical Approach
Existing actors
• See XDW, XDS-I and DSUB
New actors
- Remote Read Requester
- Remote Read Scheduler
- Remote Read Reader
Existing transactions
• See XDW, XDS-I and DSUB
New transactions (standards used)
None
Impact on existing integration profiles
None – New Profiles are proposed.
New integration profiles needed
Remote Read Workflow Definition (RRWD): A content profile based on the Workflow Definition Template. This content profile captures, in a document, the Imaging Read Workflow definition for remote reading. The document is intended for use by the Cross-Enterprise Document Workflow Integration profile.
6. Support & Resources
Canada Infoway SCWG-10 has led the development of this proposal and intends to collaborate with IHE on the development of the Remote Read Workflow Definition.
PCC has expressed willingness to collaborate with IHE Rad.
VA has an extensive remote read need and would be a good candidate for working with on this profile.
UK, Italy, the Netherlands and other regions within Europe who have deployed XDS, XDS-I and XDW.
7. Risks
<List technical or political risks that will need to be considered to successfully field the profile.>
8. Open Issues
<Point out any key issues or design problems. This will be helpful for estimating the amount of work and demonstrates thought has already gone into the candidate profile.>
9. Tech Cmte Evaluation
<The technical committee will use this area to record details of the effort estimation, etc.>
Effort Evaluation (as a % of Tech Cmte Bandwidth):
- 35% for ...
Responses to Issues:
- See italics in Risk and Open Issue sections
Candidate Editor:
- TBA