Scheduled Workflow 2.0 - Detailed Proposal

Proposed Profile: Scheduled Workflow II

• Proposal Editor: Chris Lindop
• 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, HL7 has obsoleted and developed new message types which are more appropriate to imaging. In the past years, IHE Radiology has added several options to the original profile to fill in interoperability gaps. These options are best folded into the core profile to improve interoperability overall. Some gaps still exist for some of the actors. As a result, the level of uptake is not consistent with all actors.

The Problem

Obsolete Transactions

Obsolete Messaging for Change Order

• SWF requires support of Cancel/New Order in order to perform the Modify Order. This two step process is obsolete with the HL7 method which provides the capability to modify an order in a single transaction.
• The current HL7 method retains the original linking IDs and ordering information supporting better workflow and interoperability with the Order placer and Order Filler.

Obsolete Messaging for Placer Order Management

• SWF requires support of the obsolete ORM in order to perform the Order Placer transaction RAD-2. This message is obsolete and replaced with the OMG message. The OMG message is much more robust and is capable of supporting coded terminolgy for Order detail. Currently Order Detail partially handled using overloaded fields. IHE specifies Laterality to overload the Specimen Field.

Obsolete Messaging for Filler Order Management

• SWF requires support of the obsolete ORM in order to perform the Order Filler transaction RAD-3. This message is obsolete and replaced with the OMG message. The OMG message is much more robust and is capable of supporting coded terminolgy for Order detail. Currently Order Detail partially handled using overloaded fields. IHE specifies Laterality to overload the Specimen Field.

Obsolete Messaging for Procedure Scheduled and Procedure Update

• SWF requires support of ORM in order to perform the Order Filler transactions RAD-4 and RAD-13. This message is obsolete and replaced with the OMI message. The legacy ORM message includes overloaded fields, User-specified fields and Z-segments. All of these fields are supported in the HL7 OMI standard without modification.

Enhanced Workflow for Order Filler

Completing the Study (on the Order Filler)

• MPPS is sometimes not 100% relied on for completing the study on the modality. A major factor is the "append" use case. When a procedure step is appended, the RIS and PACS would need to re-open the study. This can be an issue if the RIS workflow has already started the next procedure step.
• Today many 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 or an Post-Processing Workstation without the extra step on the RIS.
• Options for completing the exam include:

1. Narrative text providing stronger text on the usage of MPPS procedure step Status in-progress/complete with regard to using the append usecase.
2. Usage of an MPPS event, Discharge Patient from Department, as documented in CP932.

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

Enhanced Workflow for Order Detail

Order Detail

• HL-7 and DICOM allow for codefiable Order Detail to be included from Order Entry to Acquisition.

Japan Support

• Support for Master Codes: New ORC segment may now include the JJ1017 Code (Japanese master code for Radiology)

Enhanced Patient Information Reconciliation

Patient Information Reconciliation

• PIR transactions should be part of SWF II

Image Deletion for Quality reasons

• The Image Deletion for quality reasons, developed in MAWF, should also be included in PIR, allowing for image removal for Quality reasons.

Cleanup

Patient Administration Management

• 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.

Intermittently Connected Devices, part of Cardiology ECHO

• Intermittently Connected Devices, part of Cardiology's Echo Workflow, is equally important to Radiology. Should be part of SWF for mobile devices support.

Multi-modality Study

• Multi-modality study, part of Cardiology's Cath Workflow, is equally important to Radiology. Should be part of SWF for multi-modality support.

SWF Options Baselined with SWF 2.0

• Several SWF Options, developed after the original SWF could now be made requirements for all participating actors.
  • PPS Exception Management
  • Availability of PPS Referenced Instances
  • Instance Availability Notification
  • Assisted Protocol Selection

Key Use Case

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

Only the use cases identified in this proposal should be under consideration.

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.

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

Create a new profile that incorporates all the changes and new material.

Keep the old profile on the books for systems that don't want to make the leap.

Alternative: Add a V2.6 Option which includes the Operator Name, Study Ready and V2.6. Systems must maintain 2.3.1.

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 - Update the mapping tables
• 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, it's covered by Instance Availability Notification
• 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 - Do not include, reporting workflow not included
• RAD-27 Retrieve Reports - Do not include, reporting workflow not included
• RAD-42 Performed Work Status Update - Do not include?. Post-processing workflow not included
• RAD-46 Query Reporting Worklist - Do not include. reporting workflow not included
• RAD-48 Appointment Notification - Open Issue.
• RAD-50 Instance Availability Notification - no change.

New Transactions

• RAD-x2 Manage Order from Placer - Replaces RAD-2 with Enhanced Orders Management V2.5 based on the OMG message.
• RAD-x3 Manage Order from Filler Replaces RAD-3 with Enhanced Order Filler Management using the specific V2.5 OMI message.
• RAD-x4 Notify of Scheduled Procedure - Replaces RAD-4 with Enhanced Procedure Scheduled using the specific V2.5 OMI message.
• RAD-x13 Update Procedure - Replaces RAD-13 with Enhanced Procedure Update using the specific V2.5 OMI message.
• RAD-xx1 Release? Study - New Transaction to identify when the operator thinks they are done with the study and it is ready for the next step in the departmental workflow

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

None

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.
2. Review existing SWF and PIR Options, decide which to fold-in/make mandatory.
3. Include text in Volume 1 to factor out tranactions RAD-1 and Rad-12 and add PAM as a dependency or required grouping.
4. Coordinate "Study Ready" Message mechanisms with the corresponding DICOM CP
5. Create new Release Study Transaction
6. Port transactions RAD-2, RAD-3, RAD-4 and RAD-13 from HL7 v2.3.1 to current HL7 v2.5.1/2.6 with new transactions RAD-x2, RAD-x3, RAD-x4 and RAD-x13.

Extra Credit

• Included profile text to address the additional uses cases documented in the 2007-2008 SWF II Whitepaper.

Support & Resources

Ruth Berge, GE Healthcare.

• Canada Health Infoway
  • Alvaro Mestre (CHI)
• IHE Eyecare
  • Mike Schmidt
• IHE Europe
  • Peter Mildenberger
  • Nick Brown
• HL7
  • Mike Henderson

• IHE Japan and Spain
  • both have expressed interest in seeing SWF updated to HL7 v2.5.
  • There is hope that they might contribute some resources.
• IHE Mammography
  • 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

There may not be enough added value for vendors to implement/users to upgrade.

This is a not a major concern. SWF currently uses obsolete messages. Many national requirements include HL7 v2.5 or greater today, making conformance to SWF not possible. SWF 2.0 gives the vendors a path for upgrade without obsoleting their current capabilities.

The mechanisms might be too extensive for vendors to take on:

Some implementers might decide not to support PAM requirements for outpatient imaging centers.

Conveying operator identity may provide minimal benefit if the values/codes are not synchronized across the organization scope of this profile.

This is a deployment issue. An implimentor might call a dependency on PWP or other IT technique

There may be confusion/knock-on effect to other domains which further profiled SWF. SWF will not be obsoleted without consultation with dependednt domains.

Risk: Difficulties coordination the technical approach and schedule with DICOM WG-6 for handling "Study Ready"

Though nice-to-have, "Study Ready" is not essential to the overlying need to update SWF.

Open Issues

Issue: Should the TF text use HL7 V2.6 or 2.5.1

2.6 is the newest balloted. In the context of SWF, 2.5.1 adds useful capabilities over 2.3.1, 2.6 doesn't add much over 2.5.1. Since they are backwards compatible we might as well target 2.6. On the other hand, vendors may not have committed to that change.

Issue: Address Distributed Workflow?

IHE-Canada is very interested in getting this done. It would increase the complexity of the work.

Issue: Should there be an Order Management Profile to go with the Patient Administration Management Profile?

Domain ordering practices are probably different enough that the same transactions/behaviors could not be used.

Issue: Should we eliminate the PPS Mgr and just assign it to the Order Filler?

Would be cleaner text and implementation to remove it. However, more "mixed/legacy" sites could be handled if the Image Manager also has the capability. So should the Profile document that as a requirement or make it a suggestion.

Issue: Should we extract image display behaviors from Retreive Images and put them in a separate Display Image transaction?

Architecturally the separate Display Image would be helpful. Not all retrieves involve display, not all displays involve retrieve (e.g. import, etc.).

Issue: Should the Creator Image/MPPS still be separate transactions?

Issue: Should Appointment Notification be included or not?

It might need to be re-written given the other changes. Enterprise scheduling is a gap. We could do our piece, or we could decide to leave it a gap until there is a master plan.

Issue: What is our policy for maintenance of SWF and SWF II if both are left on the books.

An immediate question is whether we add options to SWF for Intermittent Connection and Multi-modality Aquisition.

Tech Cmte Evaluation

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

• 50% for only Study Ready, Operator Name, V2.6 and fold-in of PIR & PPS Exception Option & Instance Availability & Assisted Protocol Setting
• 80% to also include Extra Credit 1
• 110% to also include Extra Credit 1 & 2

Responses to Issues:

See italics in Risk and Open Issue sections

Candidate Editor:

Chris Lindop

Radiology_Proposals_2008-2009