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 9 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 and Cardiology 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 This two step process is obsolete with the HL7 method which provides the capability to modify an order in a single transaction.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 This message is obsolete and replaced with the OMG message.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 This message is obsolete and replaced with the OMG message.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.

Overloaded Message for Procedure Scheduled and Procedure Update

SWF requires support of ORM in order to perform the Order Filler transactions RAD-4 and RAD-13 to notify the PACS of an Order Scheduled. This message is not the intyenced use for thisa application. HL7 v 2.5.1 added the OMI message for this purpose. 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:

Narrative text providing stronger text on the usage of MPPS procedure step Status in-progress/complete with regard to using the append usecase.
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 with Order Detail

Order Detail

HL-7 2.5.1 and DICOM 2008 both allow for codefiable Order Detail to be included from Order Entry to Acquisition.

Japan Support needed for Master Codes

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

Enabling Distributed Workflow with CP 800

Leveraging CP800 to enable distributed workflow by utlizing CP 800 to transform locally unique Identifiers to globally unique.

Enhanced Patient Information Reconciliation

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 regarding patient management.
- PAM effectively replaces SWF transaction RAD-1 and PIR transaction 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 Review 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
- Evidence Creator - MPPS

Key Use Case

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

The primary focus should be with Order Detail.

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 legacy systems.

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 - Replace, 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 OMG 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 - Retire, it's covered by Instance Availability Notification
RAD-12 Patient Update - Replace, 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 - no change
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 OMG 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 Acquisition Complete - 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 will become obsolete in the future by this and other profiles.

Breakdown of tasks that need to be accomplished

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.
Review existing SWF and PIR Options, decide which to fold-in/make mandatory.
Include text in Volume 1 to factor out tranactions RAD-1 and Rad-12 and add PAM as a dependency or required grouping.
Coordinate "Study Ready" Message mechanisms with the corresponding DICOM CP
Create new Release Study Transaction
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

GE Healthcare
- Ruth Berge
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.

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

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.

Open Issues

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

2.6 is the newest balloted and we are requiredd by HL-7 MOU to use the most current baloted version. In the context of SWF, 2.5.1 adds required capabilities over 2.3.1, 2.6 doesn't add anything useful over 2.5.1 in context of SWF. Since they are backwards compatible we could well target 2.6.

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 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):

Responses to Issues:

See italics in Risk and Open Issue sections

Candidate Editor:

Chris Lindop

Radiology_Proposals_2009-2010