SWF.b Assisted Protocol Option Extension

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1. Proposed Workitem: <initial working name for profile/whitepaper/etc>

• Proposal Editor: Chris Lindop
• 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

2. The Problem

IHE has defined two profiles regarding how acquisition protocoling is performed and managed. They are Management of Acquisition Protocols and Scheduled Workflow, Assisted Protocol Option. IHE has not defined how these profiles interact.

Management of Acquisition Protocols defines actors, and a centralized process for managing Protocols across modalities, and the SWF.b Assisted Protocol Option provides for the capability to communicate to the acquisition modality, the recommended protocols for the acquisition.

There is a natural grouping of Protocol Management and Protocol Prescription functionalities within the Protocol Manager Actor. Such systems are being developed as standalone systems apart from the traditional Radiology Information System. The RIS typically incorporates this Protocol Prescription capability along with resource (Modality) scheduling, however, the RIS may lack equipment specific knowledge to assign the correct protocol based on the manufacturer and model of the scheduled resource. These new systems include the incorporation of EMR clinical data (such as patient history and allergies) and AI algorithms, to improve the efficiencies of radiologists in prescribing acquisition protocols necessary to fulfill an order.

This proposal is to address how a Protocol Management System communicates to a Radiology Information System the prescription of the acquisition protocols that are known by the performing modality to be scheduled.

3. Key Use Case

An imaging service request is typically created by and EMR and transferred as an imaging order to a Radiology Department Information System.

The order received by the Radiology Information System (EMR), initiates two tasks, Scheduling and Protocolling. These tasks happen independently. In this use case, these tasks are performed on two separate systems, a RIS performing the scheduling and a Protocol Management System performing the protocoling.

When the Order is received by the Protocol Management System, the order is associated with a number of radiology-specific procedures that have to be performed to satisfy the order. Each procedure prescribes a number of actions that are to be performed by Acquisition Modalities. Actions are grouped into procedure steps.

A Radiologist determines the procedure assignment and will recommend the protocols to be performed by the acquisition modalities to fill the order. This includes the acquisition protocol which identifies the settings and conditions to be used by the technologist to perform the acquisition. The Radiologist reviews the patient’s medical history, typically hosted on an EMR, to assist in this assignment. This task is performed on a Protocol Management System.

A Department Scheduler will assign the time slots and performing resource (modality) for the procedure steps. The procedure steps includes the protocol assignments by the Radiologist.

4. Standards and Systems

Systems

1. Protocol Management System
2. Electronic Medical Record Order Management System
3. Radiology Information System
4. Protocol Management System
5. Acquisition Modality

Standards

1. DICOM
2. HL7 v2
3. HL7 FHIR
4. IHE Scheduled Workflow, Assisted Protocol Option
5. IHE Management of Acquisition Protocols

5. Discussion

This proposal is to bridge two existing IHE profiles, IHE SWF.b, Assisted Protocol Option with the IHE MAP. The Protocol Manager defined in MAP will require the Order created in SWF.b by the Order Placer. This is an existing transaction [RAD-2]. The protocol assigned by the protocol Manager needs to be communicated to the Order Filler in SWF.b. This transaction is not defined in IHE. RSNA is demonstrating this capability at the RSNA 2021 IAIP demonstration and could serve as a model on how this can be achieved.

The Protocol Manager may need to know what protocol is performed by the Modality. This feedback is provided by the existing Modality in the MPPS transaction. A Protocol Manager could receive the MPPS directly from the Modality. While access to the Patient’s medical record is important to the protocoling, IHE IT has defined several profiles which should be considered as a cross profile consideration.

The Protocol Management system will require access to the list of local procedures for the department. This need can be supported by IHE ITI Shared Value Set profile as a cross profile consideration.