Scheduled Workflow 2.0 - Radiology Order Management - Brief Proposal

IHE Profile Proposal (Short)

1. Proposed Profile: Radiology Order Management

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

2. The Problem

The Scheduled Workflow Integration Profile pioneered the use cases for integrating Systems which specialized in Order Entry/Placement and Order Placement/Department Scheduling with HL-7 v2.3.1. At this time, it was the current “state of integration” for integration order placers with order fillers. There are gaps. It does not have a sufficient robust feedback mechanism from the order filler to the order placer to handle exceptions and updates by the order filler. It does not provide adequate granularity for orders placed. These issues are addressed in later versions of HL7.

In addition the profile needs to be decoupled from acquisition. In this manner, the integration profile can be better leveraged by non-imaging workflows for Order Management.

3. Key Use Case

This Integration profile leverages the same use cases as scheduled workflow at a high level. The primary difference is with granularity of the order by the order placer and the feedback returned by the order filler. This use case was documented in the Japan National Extension.

Some of the other needs do include:

• capability for an order filler to change the order without necessarily canceling the order first, as IHE SWF currently requires.
• Order filler to provide a more granular feedback mechanism indicating when an order is modified, cancelled held or resumed. Provisions should include an acceptance mechanism for an order filler to proceed if an order is changed.
• Order placer to provide a more granular order, including modality and protocol to be performed

4. Standards & Systems

The existing systems that are involved today, include clinical information systems which are capable of placing radiology orders. And Radiology Information Sysdtems which are capable of order filling.

Relevant standards: HL-7 v2.5 or greater.

5. Discussion

This integration profile was identified as a critical need by our Japan National Committee. It was identified as highly desirable by some of our North American users. The need became most visible in the IHE Radiology investigation of an HL-7 Versioning Roadmap Strategy. While the intent of this Integration Profile is not to solve the issue HL-7 versioning Roadmap Strategy for the IHE Radiology Domain, it is intended to meet the current concerns which have identifies HL-7 v2.3.1 as not adequate given today’s workflow internationally. This approach coincides with the proposed Solution 3: New Profile to refactor SWF (Patient, Order and Acquisition) and upgrade to HL7 v2.5 Briefly the proposal is intended to

1. Remove the HL7 Patient Demographics transactions from IHE Radiology and use the IHE ITI Patient Demographics Management (PAM) transaction.

2. Normalize the remainder of SWF to cover only Acquisition Workflow (AWF). This would include potentially making changes such as: a separate set of transactions should cover the Radiology Order Management (RAD-OM) so that other Domains can easily change out the HL7 Order information as needed and creating a cleaner delineation between acquisition, post-processing and reporting.

3. Reviewing the SWF and potentially making changes to improve the profile. This includes making exception handling required as opposed to an option, reviewing the use of MPPS, etc.