understanding clinical workflowsunderstanding clinical workflows dr neelam dugar the uk pacs &...

Understanding Clinical WorkflowsDR NEELAM DUGAR

The UK PACS & Teleradiology Groupwww.pacsgroup.org.uk

CHAIRMAN OF

http://www.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)



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


2. Chest CT3. MRI



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


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



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



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


2. Chest CT3. MRI


2. Chest CT3. MRI


Reporting Workflow


Local Imaging HistoryLocal Imaging HistoryChest XChest X--Ray Ray


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 Workflow

Request Request Card/OrdercommCard/Ordercomm

ssLocal Imaging HistoryLocal Imaging History

Chest XChest X--Ray Ray Chest CTChest CT

MRIMRI RISRIS

DD/VRDD/VR


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)



Access to EPR

Improves patient

SAFETY



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



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”



Patient Centric Care

(use XDS)

Integrated Health Record



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 Workflow


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 Workflow


National Imaging HistoryNational Imaging HistoryChest XChest X--Ray Ray


DD/VRDD/VR

National Imaging History XDS• Chest X-Ray

• Chest CT• MRI

1. ECG

2. Endoscopy

3. Blood Results

4. Histology



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



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)




TITLE OF SUBJECT

Current Screening MammogramCurrent Screening Mammogram PACSPACS-- RadiologyRadiology

PACS- Rad..EPRPACS- Bre...PACS- Rad...


Breast Screening






TITLE OF SUBJECT

Current Screening MammogramCurrent Screening Mammogram EPREPR-- National XDS RegistryNational XDS Registry

PACS- Rad..EPRPACS- Bre...PACS- Rad...


Breast Screening



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



Discharge Summaries WorkflowEPREPR-- XDS Based RegistryXDS Based Registry


Clinical Letters SystemClinical Letters System

DD/VRDD/VR

Discharge Discharge Letters Letters SystemSystem

1. ECG

2. Endoscopy

3. Blood Results

4. Radiology



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


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



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


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...



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



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


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