Scheduled Workflow 2.0 - Detailed Proposal

Proposed Profile: Scheduled Workflow II

• Proposal Editor: Chris Lindop/Ruth Berge/Tony Palmer
• Date: N/A (Wiki keeps history)
• Version: N/A (Wiki keeps history)
• Domain: Radiology

Summary

The Scheduled Workflow Integration Profile for the Radiology Domain was first introduced in the IHE Technical Framework Version 1 over 8 years ago. Since the introduction, IHE Radiology has added several options to make it more operable. Additionally, some of the early technology did not address all of the interoperability needs due to limitations of the technology. As such, the level of uptake is not consistent with all actors.

The Problem

Completing the Study (on the Order Filler)

• MPPS can not be relied on for completing the study on the modality.
• Today most sites have a RIS terminal in the suite where the operator manually "completes" the study.
• It would be better if the tech manually completed it on the modality and remove the need for the "rolling chair" and extra terminal.
• Would like other steps to also indicate they are finished their bit.

Obsolete Messaging for Change Order

• SWF requires support of Cancel/New Order in order to perform the Modify Order.
• Most sites currently use a Modify Order transaction because you retain the original linking IDs, etc. Less cleanup.
• It would be nice if IHE blessed this and made it baseline

Operator Name at the Order Filler

• The Order Filler needs the operator name to close the study because it would avoid manual entry for billing and management of staff resources/workflow
• MPPS does not identify the operator
• This may be in the images but the Order Filler shouldn't need to open those
• It would be better if this information was recieved automatically (e.g. in the MPPS).

Overloaded HL7 Fields

• SWF on 2.3.1 works, but it uses overloads existing fields and uses Z segments
  • Views: SWF overloads the OBR field for specimen with views.
  • Support for Master Codes: New ORC segment may now include the JJ1017 Code (Japanese master code for Radiology)
  • Result Study UID: Current ORR does not normally provide the Study UID to reference. SWF added a custom ZDS Segment to handle Study Instance UID in Transactions RAD-4 and RAD-13. HL7 v2.5 formally defines it in the OMI
• It would be better if it continued to work but did the same thing using the new fields and segments in 2.6

Patient Information Reconciliation

• It was not included in SWF for historical reasons.
• It would be better if PIR was part of SWF (like Card had the opportunity to do)
  • PIR transactions and use cases should be part of SWF II

National Focus on HL7 Version Numbers

• Some countries are requiring national purchases to use particular versions (e.g. 2.5.1)
• Vendors could support that, and also claim IHE SWF using 2.3.1 but they wouldn't be able to show 2.6 on their Integration Statement.
• Some countries are requesting V3.

Patient Administration Management Adoption

• SWF includes patient management because it wasn't' profiled at the time of SWF development.
• PAM from ITI domain provides a common approach for all domains for patient management.
  • PAM effectively replaces SWF transactions RAD-1 and RAD-12.
• It would be better if IHE Rad factored out patient management and just referenced PAM instead.

Key Use Case

The SWF II whitepaper has identified use cases that are not addressed by SWF but could be useful to address.

This SWF II proposal would not address any new use cases beyond SWF.

Only Use Cases which address Radiology Acquisition will be part of the workscope.

It is proposed that the committee spend time on a limited analysis of distributed workflow use cases but not write technical text to address them.

Standards & Systems

HL-7 v2.5.1 (Released)

HL-7 v 2.5.1 is the most relevant version of HL-7 to SWF II. HL-7 v 2.5.1 is identified as a critical need by the Japan National Committee and the Spain National Committee.

HL-7 v2.6 (Released)

The initial assessment by the Rad TC is that v2.6 has no additional features useful or relevant to SWF II, but this profile would use 2.6 to remain "current".

HL-7 v2.7 (In Development)

The initial assessment by the Rad TC is that v2.7 has no additional features useful or relevant to SWF II.

The initial assessment by the Rad TC is that SWF II will not define any additional requirements relevant to v2.7 development.

HL-7 v3.x (In Development)

The initial assessment by the Rad TC is that the impact of HL-7 v3.x is so significant that it warrants a separate profile.

Regional HL-7 Version Requirements

see strawman process described in open issues section

DICOM

5. Technical Approach

Existing Actors

Order Placer

Order Filler

Evidence Creator

Acquisition Modality

Image Manager

New Actors

None proposed.

Existing Transactions

The following changes are proposed for each transaction:

• RAD-1 Patient Registration - Remove PAM transactions supersede
• RAD-2 Orders Management - Replace with Enhanced Orders Management V2.5 based on the OMG message.
• RAD-3 Order Filler Management Replace with Enhanced Order Filler Management using the specific V2.5 OMI message.
• RAD-4 Procedure Scheduled - Replace with Enhanced Procedure Scheduled using the specific V2.5 OMI message.
• RAD-5 Query Modality Worklist - no change
• RAD-6 Modality Procedure Step In Progress - Add operator ID
• RAD-7 Modality Procedure Step Complete - Add operator ID
• RAD-8 Modality Images Stored - no change
• RAD-10 Storage Commitment - no change
• RAD-11 Image Availability Query - remove
• RAD-12 Patient Update - Remove PAM transactions supersede
• RAD-13 Procedure update - Replace with Enhanced Procedure Update using the specific V2.5 OMI message.
• RAD-14 Query Images - no change
• RAD-16 Retrieve Images - no change
• RAD-18 Creator Images Stored - no change
• RAD-19 Creator Procedure Step In Progress - Add operator ID
• RAD-20 Creator Procedure Step Complete - Add operator ID
• RAD-26 Query Reports - remove, reporting workflow not included
• RAD-27 Retrieve Reports - remove, reporting workflow not included
• RAD-42 Performed Workstatus Update - remove. Post-processing workflow not included
• RAD-46 Query Reporting Worklist - remove. reporting workflow not included
• RAD-48 Appointment Notification - remove. scheduling not included.
• RAD-50 Instance Availability Notification - no change.

New Transactions

• RAD-x2 Enhanced Orders Management - Replaces RAD-2 with Enhanced Orders Management V2.5 based on the OMG message.
• RAD-x3 Order Filler Management Replaces RAD-3 with Enhanced Order Filler Management using the specific V2.5 OMI message.
• RAD-x4 Procedure Scheduled - Replaces RAD-4 with Enhanced Procedure Scheduled using the specific V2.5 OMI message.
• RAD-x13 Procedure Update - Replaces RAD-13 with Enhanced Procedure Update using the specific V2.5 OMI message.
• RAD-xx1 Study Complete - New Transaction to identify when the operator thinks they are done with the study and the next step in the departmental workflow may be initiated

Impact on existing integration profiles

Scheduled Workflow and Patient Information Reconciliation Profiles are not impacted. They may become obsolete in the future by this and other profiles.

New Integration Profiles Needed

Create Radiology Acquisition Workflow

Breakdown of tasks that need to be accomplished

1. Modify and review new volume one Profile for Radiology Acquisition Workflow(supersedes SWF II). Use cases to include usage of Operator ID and Study Complete Transaction. Use cases to include additional use cases developed in 2007-2008 as guidelines for usage to the enhanced capabilities. Profiling any additional tranactions based on these use cases is out of scope.
2. Review existing SWF and PIR Options
3. Include text in Volume 1 to factor out tranactions RAD-1 and Rad-12 with requiring PAM grouping.
4. Create CP for Study Complete Message
5. Create new Study Complete Transaction in Volume 3
6. Port transactions RAD-2, RAD-3, RAD-4 and RAD-13 from HL7 v2.3.1 to current HL7 v2.5 with new transactions RAD-x2, RAD-x3, RAD-x4 and RAD-x13.
7. Update 3 with ported transactions.
8. Review the Optionality defined for each tranaction based on new cross-domain guidelines.

Alternate Option 1 Remove Study Complete message from workscope.

Alternate Option 2 Profile the enhance capabilities defined in the 2007-2008 use case development.

Support & Resources

The resource support committed to this profile are high. Commitment of resources from National Committees, the Radiology Subcommittees and other Domain Committees have all expressed their commitment for a new SWF.

Specifically:

• The Japan and Spain National Committees both have expressed interest in seeing SWF updated to HL7 v2.5.
• The Mammography Subcommittee has expressed their need for some of the departmental workflow enhancements identified and their willingness to work with the re-factoring to support their needs.

Risks

1. PAM requirements may be too extensive for outpatient imaging centers.
2. Limiting the HL7 workscope to the porting of the SWF Transactions and fields from 2.3.1 to 2.5.1 may not be sufficient to meet current needs of the systems today.
3. Operator identity may not match between systems without the common sharing of operator identities without the use of PWP or other IT technique to synchronize operator personell identity.
4. Domains outside of Radiology will need to consider which version/s of SWF to use. This evaluation may introduce scope creep.

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:

Chris Lindop

Radiology_Proposals_2008-2009