IHE EyeCare Workflow , Ophthalmology Workflow

Ophthalmology Workflow

Eye Care Workflow*

(Image Management)

The Eye Care Workflow Integration Profile establishes the continuity and integrity of basic patient and procedure data in the context of an eye clinic and/or an integrated hospital workflow scenario.

This profile deals specifically with consistent handling of patient identifiers and demographic data. It also specifies the scheduling and coordination of procedure data to a wide variety of diagnostic imaging and testing equipment, and its reliable storage in an image management system from where it is available to support subsequent workflow steps, such as reporting.

It also provides the ability for the acquisition devices to identify the actual procedure(s) that were performed. This enables further workflow steps such as automated billing.*

http://wiki.ihe.net/index.php?title=Eye_Care_Workflow

IHE EyeCare "Actors"

Acquisition Modality

A system that acquires and creates medical images while a patient is present. In eye care, modalities acquire diagnostic information such as images and/or evidence documents. Some examples of these may include photography, topography, refractive exams, corneal and retinal topography, visual fields, etc.

Required Transactions:
- Query Modality Worklist
         - Patient Based Worklist Query
         - Broad Worklist Query
- Modality Procedure Step In Progress
- Modality Procedure Step Completed
- Modality Images/Evidence Stored
- Storage Commitment

Options:
- Billing and Material Management
- Assisted Acquisition Protocol Setting
- PPS Exception Management
- Eye Care Image Option* (see note 1)
- Encapsulated PDF Option for Evidence Documents* (see note 1)
- Eye Care Measurement Option * (see note 1)
- Relative Image Position Coding Option
- Stereo Relationship Option
- Patient Instructions Options

Acquisition Modality Importer

A system that interfaces to a non-DICOM ready modality in order to integrate that modality into the Eye Care workflow.

Required Transactions:
- Query Modality Worklist
        - Patient Based Worklist Query
        - Broad Worklist Query
- Modality Procedure Step In Progress
- Modality Procedure Step Completed
- Modality Images/Evidence Stored
- Storage Commitment

Options:
- Billing and Material Management
- Assisted Acquisition Protocol Setting
- PPS Exception Management
- Relative Image Position Coding Option
- Stereo Relationship Option
- Patient Instructions Options
- Encapsulated PDF Option for Evidence Documents* (see note 1)
- Eye Care Measurement Option * (see note 1)

Image Manager / Image Archive:

Image Manager - A system that provides functions related to safe storage and management of evidence objects. It supplies availability information for those objects to the Department System Scheduler. Image Archive – A system that provides long-term storage of evidence objects such as images, presentation states, Key Image Notes and Evidence Documents.

Required Transactions:
- Procedure Scheduled
- Modality Procedure Step In Progress
- Modality Procedure Step Completed
- Modality Images/Evidence Stored
- Storage Commitment
- Patient Update
- Images Availability Query
- Procedure Updated
- Query Images
- Retrieve Images

Options:
- PPS Exception Management
- Instance Availability Notification
- Stereo Relationship Option

Image Display

A system that offers browsing of patients’ studies. In addition, it may support the retrieval and display of selected evidence objects including sets of images, presentation states, Key Image Notes, and/or Evidence Documents.

Required Transactions:
- Query Images
- Retrieve Images

Options:
- Relative Image Position Coding Option
- Encapsulated PDF Option for Evidence
- Stereo Relationship Option

Performed Procedure Step Manager

A system that re-distributes the Modality Performed Procedure Step information from the Acquisition Modality or Acquisition Modality Importer to the Department System Scheduler/Order Filler and Image Manager.

Required Transactions:
- Modality Procedure Step In Progress
- Modality Procedure Step Completed

Options:
none

Department System Scheduler/Order Filler

A department-based system that provides functions related to the management of orders received from external systems or through the department system’s user interface. The Department System Scheduler/Order Filler informs the Order Placer of the initiation, cancellation, or change in the status of an order.

Required Transactions:
- Patient Registration
- Patient Update
- Placer Order Management
- Filler Order Management
- Procedure Scheduled
- Query Modality Worklist
- Modality Procedure Step In Progress
- Modality Procedure Step Completed
- Procedure Updated

Options:
- Billing and Material Management
- Assisted Acquisition Protocol Setting
- PPS Exception Management
- Appointment Notification
- Instance Availability Notification
- Instructions for Performing a Procedure- Filler Order Management
- Instructions for Performing a Procedure- Placer Order Management
- Patient Instructions Option

Evidence Creator

A system that creates additional evidence objects such as derived images or measurements (Evidence Documents), and transmits them to an Image Archive (for instance, acquisition modalities, image displays, post processing systems, EHR, etc.)

Required Transactions:
- Modality Images/Evidence Stored
- Storage Commitment

Options:
none

Order Placer

A hospital or enterprise-wide system that generates orders for various departments and distributes those orders to the correct department. The Order Placer informs the Department System Scheduler/Order Filler of the initiation or cancellation of an order.

Required Transactions:

- Patient Registration

- Patient Update

- Placer Order Management

- Filler Order Management

Options:

- Appointment Notification

- Instructions for Performing a Procedure-Placer Order Management

- Instructions for Performing a Procedure- Filler Order Management

Practice Management / ADT / Patient Registration

A system responsible for adding and/or updating patient demographic and encounter information (Admission/Discharge/Transfer). In particular, it registers a new patient with the Order Placer and Department System. Some possible eye care examples include a Practice Management System (PMS) or a Hospital Information System (HIS).

Required Transactions:

- Patient Registration

- Patient Update

Options:

No options defined

Transaction Descriptions & "What they Do"

Required Transaction

Transactions are interactions between actors that transfer the required information through standards-based messages.

Account Management
- The ADT Patient Registration Actor informs the Charge Processor about creation, modification and ending of the patient’s account. [RAD-36]

Charge Posted
– The Department System Scheduler/Order Filler sends descriptions of potential procedure and material charges. [RAD-35]

Displayable Report Storage
– A Report Creator sends a draft or final diagnostic Encapsulated Document report to the Report Repository. [EYECARE-7]

Filler Order Management
– The Department System Scheduler/Order Filler informs the Order Placer of the initiation, cancellation, or change in the status of an order. The Placer/Filler Order Management transaction will sometimes be referred to as “-New” when a new order is being initiated, or as “-Cancel” when an existing order is canceled. [RAD-3]

Instructions for Performing a Procedure (Placer Order Management)
- When an order is created, an Order Placer provides a mechanism for the health care provider to enter free text instructions to the technician who will be performing the procedure. [EYECARE-10]

Instructions for Performing a Procedure (Filler Order Management)
- When an order is created, a DSS/Order Filler provides a mechanism for the health care provider to enter free text instructions to the technician who will be performing the procedure. [EYECARE-10]

Modality Procedure Step In Progress – An Acquisition Modality or Acquisition Modality Importer notifies the Performed Procedure Step Manager of the start of a new Procedure Step and the PPS Manager informs the Department System Scheduler/Order Filler and Image Manager. [RAD-6]

Modality Procedure Step Completed
– An Acquisition Modality or Acquisition Modality Importer notifies the Performed Procedure Step Manager of the completion of a Procedure Step and the PPS Manager informs the Department System Scheduler/Order Filler and Image Manager. [EYECARE-6], derived from [RAD-7]

Modality Images/Evidence Stored
– An Acquisition Modality or Acquisition Modality Importer sends acquired or generated images, waveforms, or other evidence documents to the Image Archive. [EYECARE-2], derived from [RAD-8]

Patient Registration

–The ADT system registers and/or admits a patient and forwards the information to other information systems. [RAD-1]

Patient Update

– The ADT Patient Registration System informs the Order Placer and the Department System Scheduler/Order Filler of new information for a particular patient. The Department System Scheduler may then further inform the Image Manager. [RAD-12]

Placer Order Management

– The Order Placer informs the Department System Scheduler/Order Filler of the initiation or cancellation of an order. The Placer/Filler Order Management transaction will sometimes be referred to as “-New” when a new order is being initiated, or as “-Cancel” when an existing order is canceled. [RAD-2]

Procedure Update

– The Department System Scheduler/Order Filler sends the Image Manager updated order or procedure information. [RAD-13]

Procedure Scheduled

– Schedule information is sent from the Department System Scheduler/Order Filler to the Image Manager. [RAD-4]

Query Evidence Documents

– A user of Evidence Documents (i.e. Image Display, Evidence 560 Creators, etc.) queries the Image Archive for a list of entries representing Evidence Documents. [EYECARE-4], derived from [RAD-44]

Query Displayable Reports

– A Report Reader provides a set of criteria to select the list of entries representing diagnostic reports by patient, study, series, or instance known by the Report Repository. [EYECARE-8]

Query Images

– An Image Display queries the Image Archive for a list of entries representing images by patient, study, series, or instance. [EYECARE-5], derived from [RAD-14]

Query Modality Worklist

– Based on a query entered at the Acquisition Modality, a modality worklist is generated listing all the items that satisfy the query. This list of Scheduled Procedure Steps with selected demographic information is returned to the Acquisition Modality [EYECARE-1], derived from [RAD-5].

- Patient Based Worklist Query

- Broad Worklist Query

Retrieve Displayable Reports

– A Report Reader requests and retrieves a diagnostic report from the Report Repository. [EYECARE-9]

Retrieve Images

– An Image Display requests and retrieves a particular image or set of 580 images from the Image Archive. [EYECARE-3], derived from [RAD-16]

Retrieve Evidence Documents

– A user of Evidence Documents (Image Display, Evidence Creators, etc.) requests and retrieves an Evidence Document from the Image Archive. [RAD-44]

Storage Commitment

– A requestor (Acquisition Modality or Acquisition Modality Importer) requests that the Image Manager confirm ownership for the specified DICOM objects (images, evidence documents, or any combination thereof) that the requestor stored in the Image Archive, thus allowing the sender to delete those objects now owned by the Image Manager. [CARD-3], derived from [RAD-10]

*Information obtained,interpreted from and credit is given to : IHE EyeCare Technical Framework 2010 vol 1 & 2.

See: http://ophthalmictools.com/IHETechnicalFramework2010Volume1and2.aspx

Ophthalmic Tools

IHE Eye Care - DICOM Interoperability Consultants: Specializing in Digital Imaging Management, IHE, DICOM and EHR Workflow Solutions in Ophthalmology