Cross - Enterprise Screening Cross - Enterprise Screening Mammography - Workflow DefinitionMammography - Workflow Definition

(XSM-WD)(XSM-WD)

White Paper for 2011/2012White Paper for 2011/2012presented to thepresented to the

RAD Technical Committee, Planning Committee, RAD Technical Committee, Planning Committee, MammographyMammography

Arianna Cocchiglia, Francesca Vanzo, Luca ZalunardoArianna Cocchiglia, Francesca Vanzo, Luca ZalunardoDecember, 9December, 9thth 2011 2011

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White Paper developing

The work group started to draw up the draft version of the White The work group started to draw up the draft version of the White Paper Paper

The main themes of the work are:The main themes of the work are:

• description of the most common practices in mammography description of the most common practices in mammography screening according to several workflows and conveying screening according to several workflows and conveying them in the them in the Mammography Screening Task DiagramMammography Screening Task Diagram

• definition of the definition of the actors and transactions needed actors and transactions needed in this clinical in this clinical processprocess

• definition of a common structure for the definition of a common structure for the Workflow DocumentWorkflow Document

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The Mammography Screening Task Diagram

As As known, this White Paper relies on of theknown, this White Paper relies on of the ITI XDW profile ITI XDW profile by by using the Workflow Document which manages and gathers the using the Workflow Document which manages and gathers the details necessary about the screening process and collects:details necessary about the screening process and collects:

Workflow and Tasks Information Workflow and Tasks Information

Input Document ReferencesInput Document References

Output Document ReferencesOutput Document References

In order to enrich the Task Diagram, Input In order to enrich the Task Diagram, Input and Output Documents items and Output Documents items have have been includedbeen included

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The Mammography Screening Task Diagram

INPUT……..INPUT……..

OUTPUT- Invitation Letter

OUTPUT- Invitation Letter

TASK 1: RECRUITMENT

TASK 2a: ADMISSION

INPUT- Previous Exams- Invitation Letter

INPUT- Previous Exams- Invitation Letter

OUTPUT- Images (KOS Document)- Anamnestic Document

OUTPUT- Images (KOS Document)- Anamnestic Document

TASK 2b: ADMISSION

INPUT- Invitation Letter

……………

INPUT- Invitation Letter

……………

OUTPUT- “No admission” Document

END

OUTPUT- “No admission” Document

END

TASK 3: EVALUATION 1

INPUT- Images (KOS Document)- Anamnestic Document

INPUT- Images (KOS Document)- Anamnestic Document

OUTPUT- Report 1OUTPUT- Report 1

TASK 4: EVALUATION 2

INPUT- Images (KOS Document)- Anamnestic Document

INPUT- Images (KOS Document)- Anamnestic Document

OUTPUT- Report 2OUTPUT- Report 2

If a woman misses her scheduled appointmentOR

OR

Task 1 Task 1 4 4

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The Mammography Screening Task Diagram

Task 5 Task 5 7 7TASK 5: CS EVALUATION

INPUT- Report 1- Report 2

INPUT- Report 1- Report 2

OUTPUT- Response Report (--,++,+-)

OUTPUT- Response Report (--,++,+-)

INPUT- Response Report

INPUT- Response Report

TASK 6a: END (--)

OUTPUT- Letter to Patient

END

OUTPUT- Letter to Patient

END

TASK 6b: SECOND LEVEL (++)

INPUT- Response Report

INPUT- Response Report

OUTPUT- Letter to Patient (“Alert”)

- Planning DocumentEND

OUTPUT- Letter to Patient (“Alert”)

- Planning DocumentEND

TASK 6c: EVALUATION 3

INPUT- Images (KOS Document)- Anamnestic Document

INPUT- Images (KOS Document)- Anamnestic Document

OUTPUT- Report 3OUTPUT- Report 3

TASK 7: RESPONSE

INPUT- Report 1- Report 2- Report 3

INPUT- Report 1- Report 2- Report 3

OUTPUT- Response Report (+-+,+--)

OUTPUT- Response Report (+-+,+--)TASK 6b: SECOND LEVEL (+-+)TASK 6a: END (+--)

OR OR OR

OR

OR

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Actors and Transaction XSM–WD Diagram

Complete Complete DiagramDiagram

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Actors and Transaction XSM–WD Diagram

Complete Complete DiagramDiagram

XDS Lifecycle XDS Lifecycle Management Management

Tools coordinate Tools coordinate Workflow Workflow Document Document updatesupdates

XDS Lifecycle XDS Lifecycle Management Management

Tools coordinate Tools coordinate Workflow Workflow Document Document updatesupdates

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Actors and Transaction XSM–WD

XDW XDW Specific Specific ActorsActors

XDS XDS Specific Specific ActorsActors

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Actors and Transaction XSM–WD

Imaging Imaging Specific Specific ActorsActors

1/21/2

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Actors and Transaction XSM–WD

Imaging Imaging Specific Specific ActorsActors

2/22/2

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Actors and Transaction XSM–WD

OtherOtherActorsActors

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XSM–WD in the XDS environment

The The complete Actor and Transactions Digram shows several complete Actor and Transactions Digram shows several transactions and groupable actors transactions and groupable actors

Since the Workflow Document is meant to be constantly Since the Workflow Document is meant to be constantly updated with the information conveyed by the XDS updated with the information conveyed by the XDS transactions, we will consider the XSM-WD Workflow Document transactions, we will consider the XSM-WD Workflow Document from this point of viewfrom this point of view

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Workflow Document: Creation and update

The The Content Creator Content Creator constitutes the first version of the constitutes the first version of the Workflow DocumentWorkflow Document

The The Content Updater Content Updater modifies and adds new data based modifies and adds new data based on the tracking of the screening processon the tracking of the screening process

The The Content Consumer Content Consumer retrieves the Workflow Document retrieves the Workflow Document

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Workflow Document: Creation

The The Content Creator Content Creator constitutes the first version of a constitutes the first version of a Workflow Document and places it into a new Workflow Document and places it into a new Workflow Context Folder (stored in the Document Workflow Context Folder (stored in the Document Repository) which will be a fixed reference for the Repository) which will be a fixed reference for the Workflow Document. This actor shall:Workflow Document. This actor shall:

Create a New Workflow Context FolderCreate a New Workflow Context Folder

Generate the First Version of the XSM-WD Workflow Document with Generate the First Version of the XSM-WD Workflow Document with the Description information, the Recruitment Task setting as the Description information, the Recruitment Task setting as “Completed” the Task’s status including the Input/Output Document “Completed” the Task’s status including the Input/Output Document ReferencesReferences

Submit the Workflow Document to the Folder stored in the Document Submit the Workflow Document to the Folder stored in the Document RepositoryRepository

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Workflow Document: Update

The The ContentContent UpdaterUpdater modifies and adds new data modifies and adds new data based on the tracking of the screening process and based on the tracking of the screening process and provides it to the Document Repository and Registry provides it to the Document Repository and Registry by a Replace. The Content Updater shall: by a Replace. The Content Updater shall:

Get the only “Approved” version of the Workflow Document in the FolderGet the only “Approved” version of the Workflow Document in the FolderUpdate XSM-WD Workflow Document Description elementsUpdate XSM-WD Workflow Document Description elementsInclude the new Task, added to the content of the latest Workflow Include the new Task, added to the content of the latest Workflow Document version, with its own Input/Output Document ReferencesDocument version, with its own Input/Output Document ReferencesSave all changes in a new Workflow Document, setting as “Deprecated” Save all changes in a new Workflow Document, setting as “Deprecated” the last one and as “Approved” the current version)the last one and as “Approved” the current version)Submit the updated Workflow Document to the Folder (stored in the Submit the updated Workflow Document to the Folder (stored in the Document Repository)Document Repository)

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Workflow Document: Update

The case with The case with moremore ContentContent UpdatersUpdaters which modify and add new data which modify and add new data using a using a common latest version of the Workflow Document common latest version of the Workflow Document would succeed would succeed only for the first Content Updater who submits it. Infact the other(s) would only for the first Content Updater who submits it. Infact the other(s) would submit the Workflow Document with the documentUniqueID of a submit the Workflow Document with the documentUniqueID of a “Deprecated” Workflow Document and this can not be accepted“Deprecated” Workflow Document and this can not be accepted

Example Task 3-4Example Task 3-4: : The second radiologist Content Consumer should The second radiologist Content Consumer should always refer to the Evaluation 1 Worflow Document to avoid errors: always refer to the Evaluation 1 Worflow Document to avoid errors:

Into the Folder there will be Into the Folder there will be only one Workflow Document only one Workflow Document with the with the “Approved” status“Approved” status. All the previous ones are . All the previous ones are located into the same Folder will have a “Deprecated” located into the same Folder will have a “Deprecated” statusstatus

The second radiologist will not see the screening Images on his/her The second radiologist will not see the screening Images on his/her worklist until the first one will have finished his/her evaluationworklist until the first one will have finished his/her evaluation

Another etrieve of the “actual” Workflow Document and update of it Another etrieve of the “actual” Workflow Document and update of it only at the end of each Evaluation (for these two Tasks) only at the end of each Evaluation (for these two Tasks)

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Workflow Document: Retrieve

The The Content Consumer Content Consumer retrieves the Workflow retrieves the Workflow Document, obtains informations from it,…Document, obtains informations from it,…

This actor should retrieve the latest version which This actor should retrieve the latest version which coincides with the unique “Approved” versioncoincides with the unique “Approved” version

Input/Output Document references for each Task includeInput/Output Document references for each Task include : :

XDSDocumentEntry.uniqueIdXDSDocumentEntry.uniqueIdhomeCommunityIdhomeCommunityId

Possible Possible queriesqueries::

Find the Workflow Folder for a PatientFind the Workflow Folder for a PatientGet the Workflow Folder in which a particular Workflow Document is storedGet the Workflow Folder in which a particular Workflow Document is storedGet one or more document referenced in a Workflow DocumentGet one or more document referenced in a Workflow Document……

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XSM–WD Workflow Document

The XDM-WD Workflow Document cutomization complies The XDM-WD Workflow Document cutomization complies the XDW XML Schema which includes elements from the the XDW XML Schema which includes elements from the following standards: following standards: HL7 CDAHL7 CDA OASIS WS-Human TaskOASIS WS-Human Task

The four part The four part Document Document composition: composition:

See XDW Profile for the See XDW Profile for the detailed description of all detailed description of all WD elements WD elements

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XSM–WD Workflow Document

The XSM-WD Workflow Document The XSM-WD Workflow Document at Task 3 “Evaluation 1”:at Task 3 “Evaluation 1”:

TASK 3: EVALUATION 1

INPUT- images (KOS Document)

- anamnestic doc

INPUT- images (KOS Document)

- anamnestic doc

OUTPUT- Report 1OUTPUT- Report 1

Workflow Document Information:id : documentIdtitle : « Screening Mammography Workflow Document » effectiveTime : …confidentialityCode : …•languageCode : …patient : Jane Doe author : Dr.Kris workflowIstanceID : workflowDocumentSequenceNumber : « 3 »workflowStatus : « OPEN »workflowDefinitionReference : to workflow definition template (urn: OID:…)•XDWdocumentHistory : …

Workflow Document Information:id : documentIdtitle : « Screening Mammography Workflow Document » effectiveTime : …confidentialityCode : …•languageCode : …patient : Jane Doe author : Dr.Kris workflowIstanceID : workflowDocumentSequenceNumber : « 3 »workflowStatus : « OPEN »workflowDefinitionReference : to workflow definition template (urn: OID:…)•XDWdocumentHistory : …

XSM-WD Workflow Document

TaskList

The main Workflow Document The main Workflow Document Informations are located in the first three Informations are located in the first three part of the structurepart of the structure

Some elements are updated upon on the Some elements are updated upon on the specific Task: author, specific Task: author, workflowDocumentSequenceNumber workflowDocumentSequenceNumber workflowStatus,…workflowStatus,…

The fourth part is composed by the list of The fourth part is composed by the list of the actual and the previous Tasksthe actual and the previous Tasks

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XSM–WD Workflow Document

The XSM-WD Workflow Document The XSM-WD Workflow Document at Task 3 “Evaluation 1”:at Task 3 “Evaluation 1”:

TASK 3: EVALUATION 1

INPUT- images (KOS Document)

- anamnestic doc

INPUT- images (KOS Document)

- anamnestic doc

OUTPUT- Report 1OUTPUT- Report 1

The taskList element includes all The taskList element includes all generated Tasks itemsgenerated Tasks items

OUTPUT- Report 1OUTPUT- Report 1

XDWTaskXDWTask

taskEventHistory taskEventHistory

taskDataName : Recruitmentid :Status : COMPLETEDDate/time : Input : Lists of eligible womenOutput : Recruitment LetteractualOwner : Dr.Smith…

taskDataName : Recruitmentid :Status : COMPLETEDDate/time : Input : Lists of eligible womenOutput : Recruitment LetteractualOwner : Dr.Smith…

XDWTaskXDWTask

taskEventHistory taskEventHistory

taskDataName : Admissionid :Status : COMPLETEDDate/time : Input : Invitation Letter, Previous examsOutput : KOS Document, Anamnestic DocumentactualOwner : Dr. White…

taskDataName : Admissionid :Status : COMPLETEDDate/time : Input : Invitation Letter, Previous examsOutput : KOS Document, Anamnestic DocumentactualOwner : Dr. White…

XDWTaskXDWTask

taskEventHistory taskEventHistory

taskDataName : Evaluation 1id :Status : COMPLETEDDate/time : Input : KOS Document, Anamnestic DocumentOutput : Report 1actualOwner : Dr. Kris…

taskDataName : Evaluation 1id :Status : COMPLETEDDate/time : Input : KOS Document, Anamnestic DocumentOutput : Report 1actualOwner : Dr. Kris…

The last Task’s The last Task’s actualOwneractualOwner represents the represents the authorauthor for the general for the general information of the information of the Workflow Document Workflow Document

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Example: taskData Element in XSM-DW<ns3:taskData>

<ns2:taskDetails>

<ns2:id>3</ns2:id>

<ns2:taskType>Requested</ns2:taskType>

<ns2:name>Evaluation 1</ns2:name>

<ns2:status>COMPLETED</ns2:status>

<ns2:createdTime>YYYY-MM-DDTHH:MM:SS.0Z</ns2:createdTime>

<ns2:lastModifiedTime>YYYY-MM-DDTHH:MM:SS.0Z</ns2:lastModifiedTime>

<ns2:renderingMethodExists>false</ns2:renderingMethodExists>

</ns2:taskDetails>

<ns2:description></ns2:description>

<ns2:input>

<ns2:part name="xdw">

<reference uid="urn:oid:1.2.3.4.4.3.2.2.X"/> <!– KOS Document -->

</ns2:part>

<ns2:part name="xdw">

<reference uid="urn:oid:1.2.3.4.4.3.2.2.Y"/> <!– Anamnestic Document-->

</ns2:part>

</ns2:input>

<ns2:output>

<ns2:part name="xdw">

<reference uid="urn:oid:1.2.3.4.4.4"/> <!– Report 1 -->

</ns2:part>

</ns2:output>

</ns3:taskData>

XDWTaskXDWTask

taskEventHistory taskEventHistory

taskDataName : Evaluation 1id :Status : COMPLETEDDate/time : Input : KOS Document, Anamnestic DocumentOutput : Report 1actualOwner : Dr. Kris…

taskDataName : Evaluation 1id :Status : COMPLETEDDate/time : Input : KOS Document, Anamnestic DocumentOutput : Report 1actualOwner : Dr. Kris…

Work in progress: Work in progress: The entire The entire customization on the customization on the Screening Screening Mammography Mammography Workflow DocumentWorkflow Document