A new IHE profile has been issued for public comment. This addresses some of the workflow questions that have been discussed on this site around import of images and/or reports from external providers, and reconcilliation with local enterprise identifiers, e.g. accession number. I've included the use cases below. Comments welcome.
Import Reconciliation Workflow (IRWF)
The Import Reconciliation Workflow Integration Profile (IRWF) specifies both the data and workflow requirements for Portable Media created using Portable Data for Imaging (PDI) and digitized hardcopy imported into the Enterprise as DICOM data. Worklists and Patient Demographic Feeds are used as mechanisms to provide local patient and procedure (if relevant) information to be used in the process of reconciling the imported patient/procedure information. In addition to the specification of the reconciliation, departmental workflow methods for enabling subsequent workflow steps based upon the importation of Evidence Objects. Import Reconciliation Workflow is dependent upon the Scheduled Workflow (SWF) Integration Profile as well as the Portable Data for Imaging (PDI) Integration Profile in the case of portable media.
The important distinction between imported DICOM data and created DICOM data within the Enterprise is that critical patient demographics (e.g. Patient Name, Patient ID) and order/procedure Information (e.g. Accession Number) must be reconciled as part of the importation process. This is a requirement since the local Enterprise will typically have different identifiers (for patient, orders, etc.) from the Enterprise creating the Portable Media with the DICOM objects, or the information available from the hardcopy (through manual input, OCR, bar code scanners, etc.) As part of the creation of the DICOM Composite Objects the User does have the ability to store information about the origination of the data.
The Import Reconciliation Workflow extends the Portable Media Importer Actor and Evidence Creator by providing the workflow and a mechanism to reconcile the critical patient/order information on the Portable Media or from the hardcopy with the patient/order information already within the Enterprise. This profile specifies a number of transactions that maintain the consistency of the Enterprise patient (and procedural information) while providing a mechanism to maintain the original patient, order and procedural data of the DICOM data from the portable media or hardcopy. This profile also makes it possible to determine whether images, reports and other evidence objects associated with a particular media import have been stored (archived) and are available to enable subsequent workflow steps, such as additional acquisitions, post-processing and reporting.
The following use case scenarios express the process of importation for most clinical settings. They cover:
1. Outsourcing of the Acquisition. A Primary Care provider (PCP) determines that a patient should receive a diagnostic outsourced service. The PCP does not have the facilities to perform the acquisition and it must be outsourced. The PCP may order a procedure to be performed at another facility. The patient is seen at the acquisition center and the procedure is performed as requested by the order. The acquisition center creates a Portable Media (and/or films) of the examination. Per direction, the patient returns to the facility of the PCP. The images are imported into the patientís record. The data is read and a report is created. The order is completed.
2. Outsourcing of the Reading. A Primary Care Provider (PCP) determines that a patient should receive a diagnostic service. The PCPís facility does not have the resources to perform the reading and it must be outsourced to another facility. The PCP orders a procedure to be performed. The patient is seen at the acquisition modality and the procedure is performed as requested by the order. Portable media #1 of the examination is created and sent to a Reading Center. The Reading Center imports the images into its PACS and reads the images. Portable Media #2 is created with the results included and sent to the PCP. The results are imported into the patientís record. The PCP notes that the order is completed.
3. Importation of historical data. A patient is referred to an Oncologist. The Oncologist wishes to review the related patientís radiological history. The Oncologist requests the most recent study, recent prior studies, and the baseline study, which are several years old. It should be noted that the oldest exams are archived at an off-site film. The Oncologist requests that the baseline exam and relevant priors be used in conjunction with the new studies to be performed. The baseline exam is digitized (DICOM Secondary Capture) at the library and sent to the specialist via portable media along with the other relevant studies. The baseline exam results are imported into the patientís record. The Oncologist now has access to multiple studies performed over several years for the work-up and diagnosis.
4. Referral for Consultation. A Primary Care provider (PCP) determines that a patient should be referred to a cardiologist for further evaluation. The patient has had a history of cardiac issues, so the PCP sends the patient with a Portable Media containing relevant Images, Reports and Evidence Documents to the Cardiologist. The patient is registered at the Institution, and as part of the consultation the Cardiologist reviews the contents of the Portable Media and determines that the patient requires further evaluation. In this case the Cardiologist may choose to review the relevant data directly off the Portable Media and only import the data if further evaluation is required, or the data may be imported into the system as part of the scheduling of the Consultation.