swf options/charge posting andrei leontiev dynamic imaging ihe radiology planning committee
TRANSCRIPT
SWF Options/Charge Posting
Andrei LeontievDynamic Imaging
IHE Radiology Planning Committee
June 28-29, 2005 IHE Interoperability Workshop2
Scheduled Workflow Options
• Multiple options Scheduled Workflow Profile allow certain degree of workflow “tune-up”– Managing Workflow: Patient-based or Broad
Worklist Queries, Assisted Protocol Setting, Exception Management, Billing and Material Management
– Notifications of Performed Work Status or Availability of Results: Images, Other Evidence documents, Appointments
June 28-29, 2005 IHE Interoperability Workshop3
Modality Options in SWFTransaction Diagram
Query Images [14] Retrieve Images [16]
Image Display
Storage Commitment [10]
Modality Image Stored [8] Storage Commitment [10]
Creator Images Stored [18]
Procedure Scheduled [4] Image Availability Query [11] Procedure Updated [13] Performed Work Status Update [42] Performed Work Status Update [42]
Modality Worklist Provided [5]
Evidence Creator
Performed Procedure
Step Manager
Modality PS in Progress [6] Modality PS Completed [7] Creator PS in Progress [20] Creator PS Completed [21]
Modality PS in Progress [6] Modality PS Completed [7] Creator PS in Progress [20] Creator PS Completed [21]
Modality PS in Progress [6] Modality PS Completed [7]
Creator PS in Progress [20] Creator PS Completed [21]
Acquisition Modality
Image Manager
Image Archive
DSS/ Order Filler
June 28-29, 2005 IHE Interoperability Workshop4
Assisted Protocol OptionValue Proposition
• Gives the Department System Scheduler an option to directly control protocol settings on the Modality.
• Reduces variance on how procedures are performed • Centralizes configuration effort
June 28-29, 2005 IHE Interoperability Workshop5
Assisted Protocol OptionDefinition
• Actors Affected– Modality
– Order Filler/DSS
– Image Manager/Archive
– Report Manager
• Transactions Affected– PPS In-Progress
• Standards Used– DICOM (Modality Worklist and MPPS)
June 28-29, 2005 IHE Interoperability Workshop6
Assisted Protocol OptionMechanism
• Mechanism– Order Filler/DSS passes Scheduled Protocol Codes to the
Acquisition Modality inside the Modality Worklist Item (DICOM)
– Modality configuration is set accordingly either automatically or manually accepted/modified by operator
– Modality populates Performed Protocol Code information in MPPS
– The Protocol Code tables in all actors have to be synchronized
June 28-29, 2005 IHE Interoperability Workshop7
PPS Exception Management OptionValue Proposition
• Provides better feedback on discontinued studies• Handles selection of wrong worklist item
June 28-29, 2005 IHE Interoperability Workshop8
PPS Exception Management Option Definition
• Actors Affected– Modality
– Order Filler/DSS
– Image Manager/Archive
– Report Manager
• Transactions Affected– PPS Completed
• Standards Used– DICOM (MPPS)
June 28-29, 2005 IHE Interoperability Workshop9
Exception Management OptionMechanism
• Mechanism– Provision of Discontinue Reason Code in PPS Completed transaction:
• Doctor cancelled procedure• Equipment failure• Incorrect procedure ordered• Patient allergic to media/contrast• Patient died• Patient refused to continue procedure• Patient taken for treatment or surgery• Patient did not arrive• Patient pregnant• Change of procedure for correct charging• Duplicate order• Nursing unit cancel• Incorrect side ordered• Discontinued for unspecified reason• Incorrect worklist entry selected• Patient condition prevented continuing
June 28-29, 2005 IHE Interoperability Workshop10
Appointment NotificationValue 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
June 28-29, 2005 IHE Interoperability Workshop11
Appointment Notification Option Definition
• Actors Affected– Order Filler/DSS
– Order Placer
• Standards Used– HL7 v. 2.4 SIU messages
• Transactions affected– Appointment Notification
June 28-29, 2005 IHE Interoperability Workshop12
Appointment Notification OptionMechanism
• Mechanism– One appointment corresponds to one or more
Scheduled Procedure Steps– Department System Scheduler/Order Filler
generates Appointment Notification messages and sends them to the corresponding Order Placer actor.
– One message may convey multiple appointments corresponding to a single order
– Order Placer receives Appointment Notification messages and internally processes them.
June 28-29, 2005 IHE Interoperability Workshop13
Appointment Notification OptionDetails
• Specifies common information for one or more appointments associated with single order
• Appointment timing is defined on the per Scheduled Procedure Step level– One message can have multiple appointments (procedure
steps)• No patient identification information is required,
thus Order Numbers are required• Specifies Procedure Code and Description
– Not all steps of the procedure may be included• Date/Time of an appointment is expected to be in
UTC– If local, UTC offset is required
June 28-29, 2005 IHE Interoperability Workshop14
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
June 28-29, 2005 IHE Interoperability Workshop15
Instance Availability NotificationValue Proposition
• Enhances mechanism that allows to obtain information about availability of newly-acquired images and other evidence objects, for further use in workflow.
• Avoids “performance penalty” of Instance Availability query mechanism that forces “managers” to poll Image Manager/Archive for availability of evidence objects.
• Provides this information to all workflow management actors.
June 28-29, 2005 IHE Interoperability Workshop16
Instance Availability Notification Option Definition
• Actors Affected– Image Manager/Archive
– Order Filler/DSS
– Post-Processing Manager
– Report Manager
• Standards Used– DICOM (Instance Availability Notification SOP Class;
Supplement 93 Final Text)
• Transactions affected– Instance Availability Notification
June 28-29, 2005 IHE Interoperability Workshop17
Instance Availability Notification OptionMechanism
• Mechanism– 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..
June 28-29, 2005 IHE Interoperability Workshop18
Instance Availability Values
• “ONLINE” – 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” – 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
June 28-29, 2005 IHE Interoperability Workshop19
Instance Availability Values
• “OFFLINE” – 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” – 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.
June 28-29, 2005 IHE Interoperability Workshop20
Instance Availability Notification OptionDetails
• 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
• 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
June 28-29, 2005 IHE Interoperability Workshop21
Instance Availability Notification OptionDetails
• 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 may add items to a corresponding worklist.
June 28-29, 2005 IHE Interoperability Workshop22
What is not in the option
• 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
June 28-29, 2005 IHE Interoperability Workshop23
Charge PostingAbstract / Scope
• The Department System Scheduler/Order Filler provides the procedure data that is used by the Charge Processor to generate claims and submit them to payors. – Fees associated with the procedures may be defined by the
Department System Scheduler/Order Filler or by the Charge Processor.
– Claim/Bill creation from charges and communication with payors is out of scope of the profile
June 28-29, 2005 IHE Interoperability Workshop24
Charge PostingValue Proposition
• Standardizes data exchange of charges from radiology to the financial systems
• Reduces the need of the billing system to have knowledge of the radiology internals.
• Charge Processor receives more complete, timely and accurate data.
June 28-29, 2005 IHE Interoperability Workshop25
Charge PostingTransaction Diagram
RAD-36: Account Management
ADT
Acquisition Modality
Performed Procedure
Step Manager
RAD-6: Modality PS In Progress RAD-7: Modality PS Completed RAD-20: Creator PS In Progress RAD-21: Creator PS Completed
RAD-6: Modality PS In Progress RAD-7: Modality PS Completed
DSS/Order Filler
Charge Processor RAD-35: Charge Posted
Report Manager
Evidence Creator
RAD-20: Creator PS In Progress RAD-21: Creator PS Completed
RAD-42: Performed Work Status Update
Post-Processing Manager
RAD-39: Workitem Completed
June 28-29, 2005 IHE Interoperability Workshop26
Charge PostingStandards Used
• Health Level Seven, Version 2.3.1: Chapter 6 - Financial Management– DFT^P03 message
• DICOM 2003 PS 3.4 Modality Performed Procedure Step SOP Class– Billing and Materials Management module – allows
Modality specify billing information, including material consumption (contrast, film, etc.)
June 28-29, 2005 IHE Interoperability Workshop27
More information….• IHE Web site: http://www.ihe.net
http://www.himss.org/IHEhttp://www.rsna.org/IHEhttp://www.acc.org/quality/ihe.htm
• Technical Frameworks• Technical Framework Supplements – Trial Implementation
• 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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