Reporting Whitepaper - Section 5

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Artifact	Encoding	Transaction	Transport	Input/Output
Patient Account	HL7 PV1	Patient Update	(HL7 Msg)	{P1-Push}
Order	HL7 ORM	Placer Order Management	(HL7 Msg)	{O1-Push}
Worklist	DICOM MWL IOD	Modality Worklist Provided	DICOM MWM C-Find	{W1-Pull}
	DICOM UPS IOD	(Query Worklist)	DICOM UPS C-Find	{W2-Pull} {W4-Pull} {W5-Pull} {W6-Pull}
		(Push Workitem)	DICOM UPS N-Create	{W2-Push} {W5-Push} {W6-Push}
Images	DICOM Image IODs	Images Stored	DICOM C-Store	{D3-Push}, {D7-Push}
		Retrieve Images	DICOM C-Store	{D3-Pull}
Performed Proc.	DICOM MPPS IOD	Modality Procedure Performed	DICOM N-Set	{D6-Push}
	DICOM UPS IOD	(Procedure Performed)	DICOM UPS N-Get	{Dx-Pull}, {Dy-Pull}
Performed Proc.	DICOM MPPS IOD	Images Stored	DICOM C-Store	{S1-Push}
Radiation Dose	DICOM SR Dose IOD	(Dose Stored)	DICOM C-Store	{D5-Push}
Procedure Log	DICOM SR PLog IOD	(Procedure Log Stored)	DICOM C-Store	{D6-Push}
Dictation Audio	???	(Audio Stored)	???	{R1-Push}
Radiology Report (Proto/Draft/Final)	HL7 CDA	(D-Report Stored)	DICOM C-Store	{R2-Push}{R3-Push}{R4-Push}
		(H-Report Stored)	(HL7-Msg)	{R4-Push}{R5-Push}
History/Allergies/ Problems/Meds	HL7 CDA-MS	???	???	{P2-Pull?}
Staff Schedule	HL7 ???	Out of scope?	???	{H1}
Staff Certifications	HL7 ???	<PWP>	???	{H2-Pull}

Performed Proc. Details using HL7 DFT?

Lab Results

Pathology Results

Patient History Sheet

Tech Interview Sheet

Bill X12

<Material from Section 3 to go in Section 5>

• Investigate CDA as an authoring and distribution format for diagnostic reports
• Two gaps are:
  • the lack of CDA report templates for a broad set of Radiology reports
  • the lack of deployed implementations using CDA

Push vs Pull

Currently most data transfer transactions are either Push or Pull, not both.

Mostly, the preference is for clients to be in control, so client inputs are Pulled (from Servers) and outputs are Pushed (to Servers). Configuration issues also favour this approach.

When bandwidth limitations cause client response times to be unacceptable to users, this is sometimes addressed by having inputs Pushed (to the client), sometimes at the cost of needing more local storage.

When explicit workflow control is "overkill", implicit workflow is sometimes implemented by having inputs Pushed (to the client). The presence of the input implies that some action should be performed on it.

When the client needs to know promptly when an (infrequently and unpredictably updated) piece of information has been updated, that input may be Pushed (to the client) to avoid excessive polling. When there is also a desire to avoid excessive broadcasts, the data push can be expanded to Publish-Subscribe.

<<Should continue to flesh out the cases where it makes sense to push inputs and pull outputs so we can add such transactions when it's appropriate and not complicate the architecture when it's not>>

<<We should start working out which nodes would prefer to pull it's inputs or have them pushed, and which would like to push it's outputs or have them pulled. It depends somewhat on the overall workflow architecture. Not sure if it goes in Section 3, Section 5, or Section 6.>>