Notification Options for Scheduled Workflow

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Notification Options forScheduled Workflow

• Feedback Enhancements
• Andrei Leontiev
• L S Consulting

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IHE Radiology Integration Profiles


Scheduled Workflow

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Patient Info. Recon-ciliation
Post-Processing Workflow
Basic Security


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Scheduled Workflow Profile
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NEW SWF Options

• Departmental Appointment Notification
• Gives the Department System Scheduler an option
  to notify Order Placer of date and time of
  scheduled examinations.
• Instance Availability Notification
• Gives the Image Manager an option to notify Order
  Filler and other workflow management actors of
  availability status of evidence objects.

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Scheduled Workflow Profile
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Departmental Appointment Notification Option
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Value Proposition

• Provides a mechanism for the Order Placer to keep
  track of appointments scheduled for a patient
  within Radiology Department
• Includes notifications of scheduling,
  re-scheduling and cancellation events
• Helps synchronization of scheduling processes
  between enterprise and radiology

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Background

• Existing Placer Order Management Transaction
  allows Order Placer specify preferred date and
  time of an order fulfillment (i.e., radiological
  examination)
• Order Filler is ultimately responsible for
  scheduling of examination as a succession of
  Procedure Steps that may require one or more
  appointments to be created
• Currently, Order Placer has no way to know when
  or where exactly the appointment will take place.

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Departmental Appointment Booking Use Case
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Appointment Notification Transaction

• Department System Scheduler/Order Filler
  generates Appointment Notification messages and
  sends them to the corresponding Order Placer
  actor.
• Order Placer receives Appointment Notification
  messages and internally processes them.

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Interaction Diagram
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Appointment Notification Transaction

• Three typical use cases
• New booking initial scheduling of an examination
  
• Re-schedule change in date/time of examination
• Cancellation examination cancellation
• Mechanism
• HL7 SIU messages
• One message may convey multiple appointments
  corresponding to a single order
• One appointment corresponds to one or more
  Scheduled Procedure Steps

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SIU Message Structure
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SCH Segment
Specifies identification information of
particular set of appointments for given Order
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SCH Segment

• Specifies common information for one or more
  appointments associated with single order
• Placer Appointment ID is not used
• Filler Appointment ID is required
• Appointment timing is defined on the Resource
  Group level, per Scheduled Procedure Step
• SCH-6 has fixed value of 1
• One message can have multiple resource groups,
  thus multiple appointments (procedure steps)
• No patient identification information is
  required, thus Order Numbers are required

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RGS Segment
Marks beginning of a resource group for a
particular appointment. May contain only RGS-1.
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AIS Segment
Specifies date/time and service type for an
appointment (set of Scheduled Procedure Steps)
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AIS Segment

• Specifies Procedure Code and Description to for
  the Scheduled Procedure Step(s) included into
  this appointment
• Procedure Code in components 1-3
• Not all steps of the procedure may be included
• Those included are identified by a the text in
  component 5
• Date/Time of an appointment is expected to be in
  UTC
• If local, UTC offset is required
• No specification of location or resources (one
  should use AIG, AIL, AIP segments within the same
  group, as appropriate)

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NTE Segment
Allows Order Filler to pass additional
information, such as patient instructions, to
Order Placer
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What is not in the option

• Departmental Appointment Notification Option does
  not allow Order Placer to request re-scheduling
  it only can do it by cancel and re-order
• Transaction does not require AIL segment thus
  notifications on re-scheduling of the service
  from one location to another may not be sent
• This option does not address needs of
  enterprise-wide scheduling

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References

• Profile Option - Volume 1, Section 3.3.6
• Transactions - Volume 3, Section 4.48

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Instance Availability Notification Option
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Value Proposition

• Enhances mechanism that allows to obtain
  information about availability of newly-acquired
  images and other evidence objects, for further
  use in workflow
• Provides this information to all workflow
  management actors

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Background

• DSS/Order Filler, Post-Processing Manager, Report
  Manager need to know when acquired evidence
  objects made it to the Archive
• MPPS may be sent before objects are stored, and
  storage may fail
• MPPS is not available to all managers
• MPPS may fail or not be sent at all (media
  import)
• Existing query mechanism forces managers to
  poll Image Manager/Archive for availability of
  SOP Instances.

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Use Cases

• This option only addresses the use case when MPPS
  referencing evidence objects has been received by
  Image Manager.
• Image Manager generates Instance Availability
  Notification upon receiving of all objects
  referenced in particular MPPS.
• Cross-referencing of MPPS in IAN may compensate
  for MPPS missed by OF

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Instance Availability Notification Transaction
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Instance Availability Notification Transaction

• Image Manager/Image Archive generates an Instance
  Availability Notification message and send it to
  the DSS/Order Filler and optionally to other
  workflow managing actors (Post-Processing
  Manager, Report Manager).
• DSS/Order Filler, Post-Processing Manager, Report
  Manager receive an Instance Availability
  Notification message and internally process it.

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Interaction Diagram
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Instance Availability Notification SOP Class

• New SOP Class introduced in DICOM Supplement 93
• Normalized Service
• N-CREATE Operation only
• Can be used without association with MPPS
• Does not convey and explicitly forbids adding of
  patient or procedure identifiers
• Provides list of all object UIDs and their
  availability for retrieval, either over network
  or media (on per-image basis)

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Instance Availability Notification SOP Class

• New SOP Class introduced in DICOM Supplement 93
• No requirements when to generate notifications,
  for example
• availability of the first instance of a Performed
  Procedure Step or Study upon its reception,
• availability of an entire set of instances
  comprising a completed Performed Procedure Step
  or Study Can be used without association with
  MPPS
• Is not intended to satisfy scenarios or erroneous
  information reconciliation (see PIR profile)

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IAN N-CREATE Message Structure
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IAN N-CREATE Message Structure (cont.)
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Instance Availability Values

• ONLINE means the instances are immediately
  available from the Retrieve AE Title, and if a
  C-MOVE were to be requested, it would succeed in
  a reasonably short time
• NEARLINE means the instances need to be
  retrieved from relatively slow media such as
  optical disk or tape, and if a C-MOVE were to be
  requested from the Retrieve AE Title, it would
  succeed, but may take a considerable time
• OFFLINE means that a manual intervention is
  needed before the instances may be retrieved, and
  if a C-MOVE were to be requested from the
  Retrieve AE Title, it would fail (e.g., by
  timeout) without such manual intervention.
• UNAVAILABLE means the instances cannot be
  retrieved from the Retrieve AE Title, and if a
  C-MOVE were to be requested, it would fail. Note
  that SOP Instances that are unavailable from this
  AE may be available from other AEs, or may have
  an alternate representation that is available
  from this AE.

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Trigger Events

• Image Manager shall send only one IAN message for
  each MPPS referencing at least one evidence
  object.
• Image Manager shall sent IAN when it received ALL
  instances referenced in MPPS
• Image Manager shall send IAN to DSS/OF, and
  optionally to other actors

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Message Semantics

• Timing of a message can vary significantly
  depending on timing of MPPS and object storage
• No message may be sent if complete object set
  never arrives
• No message may be sent if objects arrive without
  corresponding MPPS
• Even when objects are included in IAN, the
  retrieval request may fail due to errors

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Expected Actions

• Actors receiving IAN message are expected to use
  its content for workflow management.
• Examples of internal actions
• The Department System Scheduler/Order Filler may
  update the procedure status internally,
  indicating that images for the procedure have
  been stored.
• The Post-Processing Manager may add or re-arrange
  items to a corresponding worklist.
• The Report Manager add items to a corresponding
  worklist.

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References

• Profile Option - Volume 1, Chapter 3
• Transactions - Volume 3, Section 4.49

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More information.

• IHE Web sites
• http//www.himss.org/IHE
• http//www.rsna.org/IHE
• http//www.acc.org/quality/ihe.htm.
• Technical Frameworks
• ITI V1.0, RAD V5.5, LAB V1.0
• Technical Framework Supplements - Trial
  Implementation
• May 2004 Radiology
• August 2004 Cardiology, IT Infrastructure
• Non-Technical Brochures
• Calls for Participation
• IHE Fact Sheet and FAQ
• IHE Integration Profiles Guidelines for Buyers
• IHE Connect-a-thon Results
• Vendor Products Integration Statements

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Questions,Comments,and/orSuggestions?