Reporting Workflow Revision - Detailed Proposal

1. Proposed Workitem: Reporting & Processing Workflow Update

• Proposal Editor: Kevin O'Donnell
• Editor: Kevin O'Donnell
• Domain: Radiology (& Cardiology?)

Summary

Post-processing and reporting workflow & dataflow in Radiology departments is increasingly complex. However, implementation and deployment of the Reporting and Postprocessing Workflow Profiles has been minimal and they do not support some forms of workflow and task management.

DICOM UPS supports a wider variety of workflow patterns, provides subscription-based task monitoring, a simpler implementation model, better data referencing, and has been successfully implemented and tested in IHE-RO for radiotherapy workflow. DICOM has approved a workitem to retire the older GP-Worklist on which the current IHE RWF and PPWF Profiles are based.

The Reporting Workflow and Post-processing Workflow Profiles can be revised/replaced to use DICOM UPS.

2. The Problem

Radiology workflows are getting more distributed; data collection, processing & reporting are more commonly spread across multiple systems, multiple locations, even multiple organizations.

Radiology workflows are getting more complex; more steps such as clinical processing, 3D reconstruction, and more combinations and permutations.

Radiology workflow logic is getting more sophisticated; there are examples of push, pull, centralized, distributed, data-driven, event-driven, etc.

This makes it harder for people and programs to know who is supposed to do what next or find out what has been done. In the case of reporting, it's hard to know what set of data is intended to be provided for a given exam, whether it is ready yet and if not, when it is expected. Worklists and performed procedure steps would help, but GP Worklist has proven to be difficult to implement and does not address some of the logic patterns.

Costs of continued ad-hoc/manual workflow likely include slower turnaround (a key metric for radiology), extra manpower for the manual tasks, lost/dropped actions, poor resource balancing, missing data, poor coordination, poor collection of performance metrics, poor tracability, etc.

Proprietary workflows sometimes address some of the above, but at a cost in flexibility and limiting choice/ability to use preferred systems.

3. Key Use Case

An imaging procedure is ordered which should be followed by running a clinical analysis package on the images, performing a CAD analysis and generating a 3D visualization. All four datasets should be considered in the interpretation and report.

• the three post-processing steps are performed by different people on different workstations
• there is more than one protocol that could be run in each step and they need to know which
• the techs (or the automated program) need to know when the input data is available for them to start their work
• they should not have to go manually retrieve their inputs
• the output data should be identified and made available to the next step
• the radiologist may not know whether to expect all 4 of the datasets or only some of them
• the radiologist does not know when each is complete or when the data is available
• when there is a failure, there should be enough information for a management system to be alerted/intervene
• there should be information in the audit trails to give some idea of how the department is performing and where the bottlenecks, if any, are

Among other things, we would like to be able to:

• request reading or consultation by another facility
• provide references and access paths for images to read, images for priors
• precisely describe the requested action
• possibly indicate who you would like to do it
• provide avenue for requester to monitor progress and get pointers to results

4. Standards & Systems

Systems include RIS, PACS, modalities, post-processing, reporting, HIS, EMR

Standards include DICOM Unified Procedure Step

UPS Status

• Final Text
• Radiotherapy implemented Sup 74 based on UPS and successfully tested at two Connectathons

5. Technical Approach

This basically involves updating the existing Reporting and PostProcessing Profiles to use UPS and any other changes that might make it easier to implement and use.

UPS Benefits

• retains many of the attributes used in GP-WL for easier transition
• much simpler object management logic
• supports push workflow, pull workflow, self-scheduling, etc.
• provides a subscription model for monitoring procedure steps
• improves referencing of input/output data, handling local network, media or XDS retrieval

Existing actors

Post-Processing Manager, Reporting Manager, Evidence Creator, Report Creator, Acquisition Modality, Image Display, Image Archive/Manager, DSS/Order Filler

Existing transactions

Modify/replace existing RWF/PPWF workflow transactions.

New transactions (standards used)

Consider new transactions for additional workflow patterns

Impact on existing integration profiles

Modify Post-Processing & Reporting Workflow Profiles

New integration profiles needed

Alternatively, create a new combined Post-Processing & Reporting Workflow Profile

Breakdown of tasks that need to be accomplished

• re-draft transactions for query, claim and report performance of tasks
• review existing use cases in the profile and update based on SIIM TRIP analysis
• consider if new attributes/timestamps are needed to capture all the TRIP benchmarks
• add transactions to address new use cases

6. Support & Resources

IHE Reporting Whitepaper

• Several years ago we did a whitepaper on reporting workflow which partly mapped it out and arrived at some conclusions. That material should be useful to this activity as well.

SIIM TRIP

• SIIM is working on mapping/modeling radiology workflow steps and patterns (first draft completed)
• good potential for collaboration on defining needs, designing solutions and promoting the result

RSNA RadLex

• work has been completed on an initial set of procedure codes and report templates.

7. Risks

• we should confirm the need/business case does exist for these profiles. They may not have failed due to technical issues.
  • Feeling is that the business case is sound. There is a need.
  • Were there other inhibitors than the complexity of the GP implementation
  • Did people implement GPWL and balk at using SR for the output?
• whitepaper work stalled due to lack of participation from reporting vendors.
  • Leverage SIIM TRIP and RadLex participants?

8. Open Issues

• we should be careful not to stray into trying to design universal workflow management.
  • Stick to describing radiology tasks.
  • Be aware of general solutions (e.g. BPEL, etc) for layers above the "leaf nodes"
  • Consider a RESTful interface to the UPS Service?
• Given that it is DICOM-based, how do we keep the EMR in the loop?

Questions:

• Should loosen the linkage to SINR as the output.
• Is this a clean compliment to the Reporting Templates?
  • Dovetail fairly easily. Don't have to be joined at the hip.
• Should we address MWL?
  • (While UPS would work, shouldn't mandate replacing MWL, but a useful compliment - perhaps add as an option to SWF)

9. Tech Cmte Evaluation

Effort Evaluation (as a % of Tech Cmte Bandwidth):

• 35% for ...

Responses to Issues:

See italics in Risk and Open Issue sections

Candidate Editor:

TBA