Difference between revisions of "Scheduled Workflow 2.0 - Detailed Proposal"

Revision as of 12:04, 10 October 2008

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

HL7 2.3.1 is obsolete

SWF is based on HL7 v2.3.1. The current balloted version is HL7 v2.5.1. We have overloaded fields and used zds segments which make SWF incompatible with later versions.

Poor utility of MPPS with Order FIllers

MPPS does not identify the operator.
MPPS can not be relied on for completing the study on the modality.

Key Use Case

This Integration profile leverages the same use cases as scheduled workflow.

Simple Case - A patient is registered, an imaging order is placed, a procedure is scheduled, and images are acquired.
Un-Scheduled Case - Images are acquired for an unscheduled procedure.
Patient Update Case - Any update to patient information.
Order Change Case - Any update to the order where the order is changed except for status change.
Abandon Case - Where an order is started, but discontinued. Valid images may have been acquired and work may be billable.
Append Case - Additional acquisition procedures steps are performed that were not part of the original order.
Group Case - A single procedure performed at the modality for multiple procedures scheduled for the patient.
Implicit Post Processing - Post processing on an imaging set implied by the acquisition worklist. Images may be transferred to a separate workstation for post-processing task completion.
Relevant Clinical Information Distribution - Critical relevant patient information provided from other EMR systems distributed to every system, including the acquisition modality through Modality Worklist.
Results Distribution - Information provided by the Order Placer to the Order Filler for Results Distribution.
Multimodality Acquisition - Where an order contains procedure steps for multi-modalities.
Intermittently Connected Devices - Where a modality may not be continuously connected to the department information system.

Most of these use cases are documented to some level throughout the Current Integration Profile.

Standards & Systems

HL-7 v2.5.1 (Released)

HL-7 v 2.5.1 is the most currently balloted and 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 (In Ballot)

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

Technical Approach

Existing Actors

Order Placer

Order Filler

Evidence Creator

Acquisition Modality

Image Manager

New Actors

None

Existing Transactions

The following changes are proposed for each tranaction:

RAD-1 Patient Registration - Remove RAD-2 Orders Management - Remove, replace with new RAD-x+1 Orders Management V2.5 using the specific OMG message. Note that this message complies with the IHE-Japan request to include the ORC segment to include the JJ1017 Code (Japanese master code for Radiology)

RAD-3 Order Filler Management - Remove, replace with new RAD-X+2 Order Filler Management using the specific V2.5 OMI message.

RAD-4 Procedure Scheduled - Remove, replace with new RAD-x+3. Procedure Schedule using the specific V2.5 OMI message.

New Transactions

New transaction/s identified:

New Integration Profiles Needed

Create Scheduled Workflow II.

Partition Scheduled Workflow (SWF) to remove the ADT transactions and add:

Patient Account Management (PAM) - Use existing ITI profile

Domains outside of Radiology will need to consider which version/s of SWF to use.

Support & Resources

The resource needs for this profile are high. It is important to obtain commitment of resources from the National Committees, the Radiology Subcomittees and other Domain Committees who would benefit from a new SWF.

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

PAM requirements may be too extensive for outpatient imaging centers
Limiting the workscope to simply porting 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.
Operator identiy may not match between systems without the common sharing of operator identities.

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(Lead Editor)/Ruth Berge/Tony Palmer

Radiology_Proposals_2008-2009

@@ Line 10: / Line 10: @@
 ==The Problem==
+===HL7 2.3.1 is obsolete===
+*SWF is based on HL7 v2.3.1. The current balloted version is HL7 v2.5.1.  We have overloaded fields and used zds segments which make  SWF incompatible with later versions.
-SWF is based on HL7 v2.3.1. The current balloted version is HL7 v2.5.1.  SWF is the most widely deployed IHE Integration Profile.  For health care providers who have already deployed systems based on IHE SWF, '''SWF is a roadblock for deployment of the current HL7 version'''.
+===Poor utility of MPPS with Order FIllers===
+* MPPS does not identify the operator.
-IHE National Committees have identified their deployment need to use HL7 v2.5.1.
+* MPPS can not be relied on for completing the study on the modality.
-:'''IHE-Spain''' has submitted a National Extension which makes use of the PID definition provided in the HL7 v2.5 definition.  This version of HL7 v2.5 better meets the requirements for dealing with Names (multiple surnames) and Identifiers associated with Patients, Physicians, etc.
-:'''IHE-Japan''' has submitted a National Extension which makes extensive use of the new Order Segments (including: OMG, ORG and TQ1).  Japan would prefer to make use of the latest HL7 v2.5 as it provides better organization for the information they require.
-:As part of the '''United States standards harmonization initiative''', HHS plans to require that all Government contracts use HL7 v2.5 or higher.
-Some specific features relevant to SWF that are '''lacking in 2.3.1''' include:
-* '''Order Granularity for views''': the ability to specify procedure details for views is non-existant.
-** SWF overloads the OBR field for specimen with views.
-** ORC segment may include the JJ1017 Code (Japanese master code for Radiology)
-** V2.5.1 provides increased Order Granularity in the fields added to the OBR in v2.4
-* '''Result Study UID''':  ORR can't 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 v2.5 formally defines it in the OMI
-SWF also has a number of '''interoperability gaps''' that need addressing, including:
-* '''Study Complete''': MPPS is identified by SWF as meaning end of exam or study complete.  MPPS only indicates that a procedure step is complete, not the exam or study. There is a need for knowing when the complete is study and available for next steps in the imaging procedure process.
-Patient Administration Management provides a common approach for all domains for patient management.  SWF had to include patient management because it wasn't' profiled at the time.  The PAM specification differs and improves on the SWF specification.  SWF II could reduce variation by '''factoring out patient management''' and referencing PAM instead.
 ==Key Use Case==