understanding clinical workflowsunderstanding clinical workflows dr neelam dugar the uk pacs &...
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Understanding Clinical WorkflowsDR NEELAM DUGAR
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
CHAIRMAN OF
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Active & Passive IT systemsActive IT System
Support workflows
Scheduling
Create images or documents
Status changes
E.g: RIS, pathology system, x-ray modalities etc
Passive IT System
Do Not Support Workflows
Storage of Images/Documents
Display of Documents and Images
E.g: PACS, XDS-EPR
The UK PACS & Teleradiology Groupwww.pacsgroup.org.ukContext
SynchronizationFront-end integration between IT systems
Radiology image and report ---common accession no. (context sharing)
2 types of Context Synchronization
Automatic—RIS and PACS
Manual—RIS/PACS with EPR
Standards---CCOW and PSA (of IHE)
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Context SynchronizationPACSPACS
PACSTITLE OF SUBJECT
PACSPACS
PACS
RISRIS
RIS
RIS Reporting RIS Reporting Worklist Worklist
URGENTURGENT1. Joe Bloggs1. Joe Bloggs--MAUMAU--Chest XChest X--RayRay2. Bob Wilson2. Bob Wilson--SAUSAU--Abdomen XAbdomen X--RayRay3. Sarah Jenkins3. Sarah Jenkins--Ward 12Ward 12-- Hand XHand X--RayRay
NONNON--URGENTURGENT1. Hannah 1. Hannah --FlorisFloris--GPGP-- Foot XFoot X--RayRay2. Joanne Hampson2. Joanne Hampson--OPDOPD-- Pelvis XPelvis X--RayRay3. James Bond3. James Bond-- 007007-- Gun XGun X--RayRay
The UK PACS & Teleradiology Groupwww.pacsgroup.org.ukAutomatic Context
Synchronization
TITLE OF SUBJECT
PACSPACS-- Current Chest XCurrent Chest X--RayRay
Current Chest X-ray
PACSPACS-- Previous Chest XPrevious Chest X--RayRay
Previous Chest X-ray
Reporting WorkflowReporting Workflow
Reporting Workflow
Request Request Card/OrdercommsCard/Ordercomms
Local Imaging HistoryLocal Imaging HistoryChest XChest X--Ray Ray
Chest CTChest CTMRIMRI RISRIS
DD/VRDD/VR
Local Imaging History1. Chest X-Ray
2. Chest CT3. MRI
Local Imaging History1. Chest X-Ray
2. Chest CT3. MRI
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Vision: Integrated Hospital EPRVendor neutral open standards
XDS/XDS-I—International Images and Document Standard for IHE
Metadata Indexing Model for Image and Document
Storage of images & documents in Local Stores
Hospital XDS
RegistryIndexing
Multiple departmental IT systems feed Hospital EPR
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Maternity System
Local Store
Clinical LettersLocal Store
Pathology System
Local Store
Cardiology PACS
Local StoreLaboratory System
Local Store
Ophthalmology PACS
Local Store
RISLocal Store
Radiology PACS
Local Store
The UK PACS & Teleradiology Groupwww.pacsgroup.org.ukVision:
Integrated EPRMultiple specialist best of breed departmental systems
Each departmental system creates ---a standard document or image as end product
Each departmental system may provide long term local archives for their documents/ images
A link for each document/image is sent to Hospital XDS Registry
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
XDS based EPR
XDS Viewer displays of documents and images which have been indexed on the XDS Registry
This is a PASSIVE system of display
No workflow tools.
Workflow is the responsibility of the Departmental systems which feed the XDS Registry
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
EPR Display of XDS metadata—(Patient :Joe Bloggs)
1. ECG
2. Endoscopy
3. Blood Results
4. Histology
5. Cardiology
6. Audiology
7. Radiology
8. Clinical Letters/Discharge Summaries
The UK PACS & Teleradiology Groupwww.pacsgroup.org.ukCurrent Radiologists’Workflow
(Automatic Context Sync)
TITLE OF SUBJECT
PACSPACS-- Current Chest XCurrent Chest X--RayRay
Current Chest X-ray
PACSPACS-- Previous Chest XPrevious Chest X--RayRay
Previous Chest X-ray
Local Imaging History1. Chest X-Ray
2. Chest CT3. MRI
Local Imaging History1. Chest X-Ray
2. Chest CT3. MRI
Reporting WorkflowReporting Workflow
Reporting Workflow
Request Request Card/OrdercommsCard/Ordercomms
Local Imaging HistoryLocal Imaging HistoryChest XChest X--Ray Ray
Chest CTChest CTMRIMRI RISRIS
DD/VRDD/VR
The UK PACS & Teleradiology Groupwww.pacsgroup.org.ukFuture --Access to Hospital EPR
(Manual Context Sync)
TITLE OF SUBJECT
PACSPACS-- Current Chest XCurrent Chest X--RayRay EPREPR-- XDS RegistryXDS Registry
EPRPACSPACSEPR
Reporting WorkflowReporting Workflow
Reporting Workflow
Request Request Card/OrdercommCard/Ordercomm
ssLocal Imaging HistoryLocal Imaging History
Chest XChest X--Ray Ray Chest CTChest CT
MRIMRI RISRIS
DD/VRDD/VR
Local Imaging History1. Chest X-Ray
2. Chest CT3. MRI
1. ECG
2. Endoscopy
3. Blood Results
4. Histology
The UK PACS & Teleradiology Groupwww.pacsgroup.org.ukFuture Radiologist
workflow1 ACTIVE SYSTEM—RIS
2 PASSIVE SYSTEMS—
PACS (automatic context synchronisation with RIS)
EPR (manual context synchronisation with RIS or PACS)
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Access to EPR
Improves patient
SAFETY
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
SHARegistry
Indexing
Hospital GLocal XDS Registry
Hospital BLocal XDS Registry
Hospital CLocal XDS Registry
Hospital DLocal XDS Registry
Hospital ELocal XDS Registry
Hospital FLocal XDS Registry
Hospital ALocal XDS RegistryHospital H
Local XDS Registry
XDS Indexing Model – SHAXDS Indexing Model – SHA
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
National NHS
RegistryIndexing
Hospital GLocal XDS Registry
Hospital BLocal XDS Registry
Hospital CLocal XDS Registry
Hospital DLocal XDS Registry
Hospital ELocal XDS Registry
Hospital FLocal XDS Registry
Hospital ALocal XDS RegistryHospital H
Local XDS Registry
XDS Indexing Model –National
XDS Indexing Model –National
The UK PACS & Teleradiology Groupwww.pacsgroup.org.ukFuture Best Practices
-Open StandardsLocal PACS may store images
Local RIS may store reports
RIS and PACS publish links to XDS Registry—Hospital/National
PACS and RIS will query the XDS Registry for local/national imaging history
IT departments may choose Vendor Neutral XDS archives to maximise their investment on storage.
“People are lonely because they build walls instead of bridges”
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Patient Centric Care
(use XDS)
Integrated Health Record
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
The UK PACS & Teleradiology Groupwww.pacsgroup.org.ukFuture Radiology Workflow
TITLE OF SUBJECT
PACSPACS-- Current Chest XCurrent Chest X--RayRay PACSPACS-- Previous Chest XPrevious Chest X--RayRay
PACSEPRPACSEPR
Reporting WorkflowReporting Workflow
Reporting Workflow
Request Request Card/OrdercommsCard/Ordercomms
National Imaging HistoryNational Imaging HistoryChest XChest X--Ray Ray
Chest CTChest CTPET CTPET CT
MRIMRI RISRIS
DD/VRDD/VR
National Imaging History XDS1. Chest X-Ray
2. Chest CT3.PET CT
National Imaging History XDS1. Chest X-Ray
2. Chest CT3.PET CT
The UK PACS & Teleradiology Groupwww.pacsgroup.org.ukFuture --Access to Hospital EPR
(Manual Context Sync)
TITLE OF SUBJECT
PACSPACS-- Current Chest XCurrent Chest X--RayRay EPREPR-- National XDS RegistryNational XDS Registry
EPRPACSPACSEPR
Reporting WorkflowReporting Workflow
Reporting Workflow
Request Request Card/OrdercommsCard/Ordercomms
National Imaging HistoryNational Imaging HistoryChest XChest X--Ray Ray
Chest CTChest CTMRIMRI RISRIS
DD/VRDD/VR
National Imaging History XDS• Chest X-Ray
• Chest CT• MRI
1. ECG
2. Endoscopy
3. Blood Results
4. Histology
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Departmental Systems
Scheduling
Support workflows—Clinical Letters/Theatres/Maternity/Path etc
Good departmental systems –efficiency gains
Need Best of breed
End product of each departmental system—document or image
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Breast Screening Workflow
TITLE OF SUBJECT
Current Screening MammogramCurrent Screening Mammogram Previous Screening MammogramPrevious Screening Mammogram
PACS- Bre...PACS- Rad...PACS- Bre...PACS- Rad...
Breast ScreeningBreast Screening
Breast Screening
National National Breast Breast
Screening Screening System System (NBSS)(NBSS)
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Breast Screening Workflow
TITLE OF SUBJECT
Current Screening MammogramCurrent Screening Mammogram PACSPACS-- RadiologyRadiology
PACS- Rad..EPRPACS- Bre...PACS- Rad...
Breast ScreeningBreast Screening
Breast Screening
National National Breast Breast
Screening Screening System System (NBSS)(NBSS)
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Breast Screening Workflow
TITLE OF SUBJECT
Current Screening MammogramCurrent Screening Mammogram EPREPR-- National XDS RegistryNational XDS Registry
PACS- Rad..EPRPACS- Bre...PACS- Rad...
Breast ScreeningBreast Screening
Breast Screening
National National Breast Breast
Screening Screening System System (NBSS)(NBSS)
1. ECG
2. Endoscopy
3. Blood Results
4. Histology
The UK PACS & Teleradiology Groupwww.pacsgroup.org.ukCardiology Workflow
TITLE OF SUBJECT
Cardiology PACSCardiology PACS EPREPR-- National XDS RegistryNational XDS Registry
EPRPACSPACSEPR
Cardiology WorkflowCardiology Workflow
Cardiology Workflow
1. ECG
2. Endoscopy
3. Blood Results
4. Histology
Cardiology Cardiology Information Information
SystemSystem
DD/VRDD/VR
National Cardiology History1. Cardiac Angiogram
2.ECG3.Echocardiogram
The UK PACS & Teleradiology Groupwww.pacsgroup.org.ukOphthalmology Workflow
TITLE OF SUBJECT
Ophthalmology PACSOphthalmology PACS EPREPR-- National XDS RegistryNational XDS Registry
EPRPACSPACSEPR
Ophthalmology Information SystemOphthalmology Information System
Ophthalmology Informati...
1. ECG
2. Endoscopy
3. Blood Results
4. Radiology
Ophthalmology Ophthalmology Information Information
SystemSystem
DD/VRDD/VR
The UK PACS & Teleradiology Groupwww.pacsgroup.org.ukClinical Letters Workflow
EPREPR-- XDS Based RegistryXDS Based Registry
EPRClinical Letters System
Clinical Letters SystemClinical Letters System
DD/VRDD/VR
Clinical Clinical Letters Letters SystemSystem
1. ECG
2. Endoscopy
3. Blood Results
4. Radiology
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Discharge Summaries WorkflowEPREPR-- XDS Based RegistryXDS Based Registry
EPRClinical Letters System
Clinical Letters SystemClinical Letters System
DD/VRDD/VR
Discharge Discharge Letters Letters SystemSystem
1. ECG
2. Endoscopy
3. Blood Results
4. Radiology
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Theatres WorkflowEPREPR-- XDS Based RegistryXDS Based Registry
EPRTheatres System
Theatres SystemTheatres System
DD/VRDD/VR
Theatres Theatres SystemSystem
1. ECG
2. Endoscopy
3. Blood Results
4. Radiology
The UK PACS & Teleradiology Groupwww.pacsgroup.org.ukMaternity Workflow
EPREPR-- XDS Based RegistryXDS Based Registry
EPRMaternity System
Maternity SystemMaternity System
DD/VRDD/VR
Maternity Maternity SystemSystem
1. ECG
2. Endoscopy
3. Blood Results
4. Radiology
The UK PACS & Teleradiology Groupwww.pacsgroup.org.ukGP Workflow
EPREPR-- XDS Based RegistryXDS Based Registry
EPRClinical Letters System
GP SystemGP System
DD/VRDD/VR
GP SystemGP System1. ECG
2. Endoscopy
3. Blood Results
4. Radiology
The UK PACS & Teleradiology Groupwww.pacsgroup.org.ukOrdercomms
EPREPR-- XDS Based RegistryXDS Based Registry
EPROrdercomms
OrdercommsOrdercomms
OrdercommsOrdercommsJoe BloggsJoe Bloggs
RequestRequest
a) Chest Xa) Chest X--ray ray b) U&Esb) U&Es
1. ECG
2. Endoscopy
3. Blood Results
4. Radiology
The UK PACS & Teleradiology Groupwww.pacsgroup.org.ukResults Acknowledgement
WorkflowResults Acknowledgement Sy...Results Acknowledgement Sy...
WORKLIST FOR WORKLIST FOR AB(CONSULTANT AB(CONSULTANT
ORTHOPAEDIC SURGEON)ORTHOPAEDIC SURGEON)UrgentUrgent1.1. Joe BloggsJoe Bloggs--MAUMAU--Chest XChest X--rayray2.2. Bob WilsonBob Wilson--SAUSAU--Abdomen XAbdomen X--rayray3.3. Sarah SmithSarah Smith--Ward 12Ward 12-- Hand XHand X--rayray
NonNon--UrgentUrgent1.1. Hannah FlorisHannah Floris--GPGP-- Foot XFoot X--rayray2.2. Joanne HampsonJoanne Hampson--OPDOPD-- Pelvis XPelvis X--rayray3.3. James BondJames Bond-- 007007-- Gun XGun X--rayray
Results Acknowledgement S...
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Results Acknowledgement Workflow
Results Acknowledgement Sy...Results Acknowledgement Sy...
Joe BloggsJoe Bloggs
Chest XChest X--rayray
There are bilateral lung There are bilateral lung metastasis. I note that the metastasis. I note that the
patient is known to have kidney patient is known to have kidney tumour.tumour.
Acknowledge Acknowledge and File Awayand File Away
PACSPACS
Results Acknowledgement S...Results Acknowledgement S...PACSPACS
Show EPR Show EPR
The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk
Results Acknowledgement Workflow
Results Acknowledgement Sy...Results Acknowledgement Sy...
Joe BloggsJoe Bloggs
Chest XChest X--rayray
There are bilateral lung There are bilateral lung metastasis. I note that the metastasis. I note that the
patient is known to have kidney patient is known to have kidney tumour.tumour.
Acknowledge Acknowledge and File Awayand File Away
Results Acknowledgement S...Results Acknowledgement S...PACSPACS
Show PACS Show PACS
EPREPR-- XDS Based RegistryXDS Based Registry
1. ECG
2. Endoscopy
3. Blood Results
4. Radiology
The UK PACS & Teleradiology Groupwww.pacsgroup.org.ukResults Acknowledgement
WorkflowResults Acknowledgement Sy...Results Acknowledgement Sy...
WORKLIST FOR AB(CONSULTANT WORKLIST FOR AB(CONSULTANT ORTHOPAEDIC SURGEON)ORTHOPAEDIC SURGEON)
UrgentUrgent1.1. Bob WilsonBob Wilson--SAUSAU--Abdomen XAbdomen X--rayray2.2. Sarah SmithSarah Smith--Ward 12Ward 12-- Hand XHand X--rayray
NonNon--UrgentUrgent1.1. Hannah FlorisHannah Floris--GPGP-- Foot XFoot X--rayray2.2. Joanne HampsonJoanne Hampson--OPDOPD-- Pelvis XPelvis X--rayray3.3. James BondJames Bond-- 007007-- Gun XGun X--rayray
Results Acknowledgement S...
Existing Departmental IT Systems
Cont
ext S
ynch
roni
satio
nXDS/XDS-I Standard
Integrated Health Record