imaging object change management (iocm) kinson ho – architect, agfa healthcare

• Imaging Object Change Management (IOCM)

Kinson Ho – Architect, Agfa HealthCare

Problem Statement

• Patient movement during acquisition• Forgot about system default (e.g. LCC vs RCC)• Human error (e.g. select wrong worklist item)

imagesstored

patientinformation

RIS

examination orders

imagesretrievedimages

retrieved

HIS

PACS

procedurescheduled

Prefetch any relevantprior studies

procedurescheduled

Prefetch any relevantprior studies

modalityworklist

report

report

report

report

RegistrationRegistration

Orders PlacedOrders Placed

Orders FilledOrders Filled

FilmFilm

FilmFolderFilm

FolderImage Manager

& ArchiveImage Manager

& Archive

FilmLightbox

FilmLightbox

reportreport ReportRepository

ReportRepository

DiagnosticWorkstationDiagnostic

Workstation

ModalityModality

acquisitionacquisitioninin--progressprogressacquisitionacquisitioninin--progressprogressacquisitioncompletedacquisitioncompleted

acquisitioncompletedacquisitioncompleted

imagesprintedimagesprinted

AcquisitionModality

AcquisitionModality

Problem Statement

• Bad situations become worse

HospitalHospital

Imaging CenterImaging CenterPhysician PracticePhysician Practice

Between Radiology and :Between Radiology and :•• IImaging specialistsmaging specialists•• NonNon--imaging cliniciansimaging clinicians PACS Y

PACS Z

Radiology Radiology --toto--RadiologyRadiology

Radiology Radiology --toto--PhysiciansPhysicians

Value Proposition• When people make mistakes, patient safety is potentially

compromised• In a distributed system, correction has to be propagated accordingly

for proper timely and accurate patient care

Imaging Object Change Management profile provides

A change management communication protocolthat has well-defined scope,

is simple to understandand least disruption

Use Cases

• Use Cases

Quality Reason (e.g. Patient Movement)

Patient Safety Reason (e.g. Incorrect View Code)

Incorrect Worklist Selection

Data Retention Expiration• Continue to rely on existing mechanisms for other changes

Scheduled Workflow

Patient Information Reconciliation

Import Reconciliation Workflow

Design Principles (1)

• Reject and Replace• Improvement with least disruption

Smart Source

Regular Image Manager + Regular Display

Smart Image Manager + Regular Display

Regular Image Manager + Smart Display• Compatible with portable media and external publication

Design Principles (2)

• Use standard DICOM Key Object Selection Document

Reuse DICOM Storage, Query/Retrieve services• A unique Key Object Document Title for each use case

(113001, DCM, “Rejected for Quality Reasons”)

(113037, DCM, “Rejected for Patient Safety Reasons”)

(113038, DCM, “Incorrect Modality Worklist Entry”)

(113039, DCM, “Data Retention Policy Expired”)

High Level Data Flow (1)

High Level Data Flow (2)

Actor / Transaction Diagram (1)

• Core actors related to Scheduled Workflow (SWF) and Import Reconciliation Workflow (IRWF)

ChangeRequester

ImageManager

ImageArchive

Importer

DSS / OFImageDisplay

Instance AvailabilityNotification

Rejection Note Stored Replacement Instances Stored

Query Images Retrieve Images Query Key Image Notes Retrieve Key Image Notes

Imported Objects Stored

ChangeRequester

ImageManager

ImageArchive

Importer

DSS / OFImageDisplay

Instance AvailabilityNotification

Rejection Note Stored Replacement Instances Stored

Query Images Retrieve Images Query Key Image Notes Retrieve Key Image Notes

Imported Objects Stored


• Actors related to Portable Data for Imaging (PDI)

ReportReader

Display

ImageDisplay

PortableMedia

Importer

PortableMedia

Creator

PrintComposer

Distribut ImagingInformation On Media





ReportReader

Display

ImageDisplay

PortableMedia

Importer

PortableMedia

Creator

PrintComposer







• Actors related to Cross Enterprise Document Sharing for Imaging (XDS-I)

DocumentRepository

ImagingDocumentConsumer

ImagingDocument

Source

WADO Retrieve Retrieve Imaging Document Set

Provide and Register Imaging Document Set – MTOM/XOP

Retrieve Images Retrieve Presentation States Retrieve Reports Retrieve Key Image Notes Retrieve Evidence Documents

DocumentRepository

ImagingDocumentConsumer

ImagingDocument

Source

WADO Retrieve Retrieve Imaging Document Set

Provide and Register Imaging Document Set – MTOM/XOP

Retrieve Images Retrieve Presentation States Retrieve Reports Retrieve Key Image Notes Retrieve Evidence Documents

Key Requirements• 5 classes of Actors

– Change Requester– Image Manager– Importer / Exporter*– Change Consumer*– Department Scheduler System / Order Filler

* Not actual actor name

Key Requirements – Change Requester• Required to group with

– Modality– Evidence Creator– Image Manager

• Create Rejection Note• Create Replacement Instances

– Metadata must be corrected• Match correct worklist• Match critical attributes

Key Requirements – Image Manager• Process Rejection Notes : Quality Reason

– Configurable Behavior• Regular Use• Hide Rejected Instances in Query/Retrieve

– Provide 2 AE Titles for each C-Find and C-Move– Configurable to restrict access to “Regular Use” AE

Key Requirements – Image Manager• Process Rejection Notes : Patient Safety or MWL Correction

– Not provide this Rejection Note in Query/Retrieve/Store– Not provide rejected instances in Query/Retrieve/Store– Not accept subsequent occurrence of rejected instances

• Process Rejection Notes : Data Retention Policy Expired– Delete the expired instances– Delete this Rejection Note– Accept subsequent occurrence of deleted instances

Key Requirements – Image Manager• Receive replacement instances• Send Instance Availability Notification to DSS/OF

– Include all available• Status: ONLINE, NEARLINE or OFFLINE

– Include rejected instances• Status: UNAVAILABLE

– Special case for Rejection of Quality Reason• Hide rejected instances• Regular Use

Key Requirements – Importer / Exporter• Includes

– Importer (IRWF)– Portable Media Creator, Portable Media Importer (PDI)– Imaging Document Source (XDS-I.b)

• Exclude Rejection Note• Exclude rejected instances

Key Requirements – Change Consumer• Includes

– Image Display (SWF or PDI)– Display, Report Reader, Print Composer (PDI)– Imaging Document Consumer (XDS-I.b)

• Rejection: Quality Reason– Configurable behaviour for showing / hiding rejected instances

and the rejection note• Rejection: Other 3 Reasons

– No Rejection Note and rejected instances

Key Requirements – DSS / OF• Receives Instance Availability Notification from Image Manager• Specially important for Worklist Correction case

– If the procedure step has no more available instances, then reset the status to Scheduled.

Next Step

• Review Trial Implementation of IOCM:

http://www.ihe.net/Technical_Framework/index.cfm#radiology

• Sign-up to participate in IHE Connectathon in early 2014

http://www.ihe.net/Technical_Framework/index.cfm

imaging object change management (iocm) kinson ho – architect, agfa healthcare

Documents

disruption slide

worse slide

regular use ae slide

imaging pdi slide

agfa healthcare slide

external publication

wrong worklist item

expired instances