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
HL7 2.3.1 is obsolete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.
Obsolete Messaging Transaction for Change Order
- Current Requires Cancel/New Order instead of Modify Order
Key Use Case
The existing use cases defined in SWF. Modification to the performance use case to cover completing the exam with the operator identity. Modification to the implicit post processing use case to cover completing the exam with the operator identity.
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
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.
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