Andrei Leontiev

1
IHE ??????????? ??

• Andrei Leontiev
• IDX Systems Corporation
• Co-Chair,IHE Technical Committee
• (??IHE-J??????? ??)

2
????????????????
3
??? ??????????????

• ?????
• IHE????HL7?????????????
• DICOM?????????????
• ??????????????
• ???????????????
• ????????
• ???

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IHE????HL7????

• HL7????
• ltMPIgt
• ADT/Patient Registration
• Order Placer
• DSS / Order Filler
• Image Manager

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ADT????

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ADT????

• 4.1 ?????????????
• Send
• Admit A01 (In Patient), A04 (Out Patient), A05
  (Pre-Admission)
• Cancel A11 (Cancel Admit), A38 (Cancel Preadmit)

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ADT???? (??)

• 4.12 ADT???????????????
• Send
• Transfer A02 (Patient Transfer)
• Update Patient Class A03 (Discharge),
  A06(Outpatient becomes Inpatient), A07 (Inpatient
  becomes Outpatient)
• Update Patient Information A08 (Update)
• Merge Patients A40 (Merge)
• Cancel A12 (Cancel Transfer), A13 (Cancel
  Discharge)

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?????????

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?????????

• 4.2 ???????????????
• Send
• New Order ORM/NW (New Order)
• Cancel ORM/CA (Cancel Order), ORM/DC
  (Discontinue)

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????????? (??)

• 4.1 ?????????????
• Receive
• A01 (In Patient), A04 (Out Patient), A05
  (Pre-Admission), A11 (Cancel Admit), A38 (Cancel
  Preadmit)
• 4.12 ???????????????
• Receive
• A02 (Patient Transfer), A03 (Discharge),
  A06(Outpatient becomes Inpatient), A07 (Inpatient
  becomes Outpatient), A08 (Update), A12 (Cancel
  Transfer), A13 (Cancel Discharge), A40 (Merge)
• 4.3 ????????????????
• Receive
• ORM/SN (New Order), ORM/SC (Status Update),
  ORM/OC (Cancel Order)

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DSS / ?????????

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????????????(DSS)/?????????

• 4.3 ??????????????
• Send
• New Order ORM/SN (New Order)
• Order Status ORM/SC (Status Change)
• Cancel ORM/OC (Cancel Order)
• 4.4 ?????????????
• Send
• ORM (procedure scheduled)
• 4.13 ?????????????
• Send
• ORM (procedure updated)

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DSS/????????? (??)

• 4.1 ?????????????
• Receive
• A01 (In Patient), A04 (Out Patient), A05
  (Pre-Admission), A11 (Cancel Admit), A38 (Cancel
  Preadmit)
• 4.12 ???????????????
• Receive
• A02 (Patient Transfer), A03 (Discharge),
  A06(Outpatient becomes Inpatient), A07 (Inpatient
  becomes Outpatient), A08 (Update), A12 (Cancel
  Transfer), A13 (Cancel Discharge), A40 (Merge)
• 4.2 ???????????????
• Receive
• ORM/NW (New Order), ORM/CA (Cancel Order), ORM/DC
  (Discontinue)

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??????????
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???????????
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??????????????
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??????????????
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??????????????
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????????????????
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DSS/????????????????
X
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???????

• ???????PACS???????????
• ?????DICOM????
• Modality Worklist Management (MWL(M))
• Modality Performed Procedure Step (PPS)
• Storage
• Storage Commitment
• Query/Retrieve

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IHE???????????????
IHE??????????????????????????????3?????HL7/DICOM
????????
???(??) ????????????
?????? ?????????????????????????????
??

• ??????? ???????????????? ???????????
  ?????????? ???????????? ??????????

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IHE????????????

• ??????3????????????????

?????????????? (Accession Number)
?????? ?????????????? 1????????????????(Reques
ted Procedure ID)
??????? ?????????? ???????(modality worklist
entry)
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?????????

• ?????? 1??? 1?? 1????

?????
??? ??????????
???????????????
??????
????
?????????
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????????????
?????
??? ???????
?????????? ?????
?????? 1
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A?????????????
Department
System Scheduler
Image
/ Order Filler
Manager
Performed
Procedure Step
Manager
AcquisitionModality
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??????????
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MWL(M)?????????????
Department
System Scheduler
Image
/ Order Filler
Manager
Performed
Procedure Step
Manager
AcquisitionModality
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??????????

• MWL????????????????????????????????????
• ????????????????(???????/ID??????/????????????????
  ???????????ID????)?????????????
• ?????????????????????????????
• MWL? ??? (???????????????????)

DICOM????HIS/RIS????????????? ??????????????????
????????
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??????????
C-FIND-RQ (with matching and return keys)
DSS/ Order Filler
C-FIND-RSP (one per match plus final response)

• DSS?????????????????????????????????
• DSS???????????????????????????????????????
• ????????DSS???(MWL????????)??????/DSS?????????

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???????????
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PPS Actors and Transactions
Department
System Scheduler
Image
/ Order Filler
Manager
Performed
Procedure Step
Manager
AcquisitionModality
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Performed Procedure Step

• Applies to Modality and Image Creator
• Convey details about procedure step(s) performed
• Conveys detailed statuses such as in progress,
  completed and discontinued
• Provides return trip feedback such as
• Scheduled information obtained via MWL
• What, when, and how was the procedure performed
• Accession Number, Patient Name/ID, procedure step
  codes, radiation dose values, material management
  data
• List of images acquired/created, Study Instance
  UID .

Not only tells that the performed step is
complete, But closes the workflow
acquisition/creation work done
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Performed Procedure Step

• Simple Case (1 SPS results in 1 PPS)
• Unscheduled Case (0 SPS results in1 PPS)
• Append Case (1 SPS results in n PPS)
• Group Case (n SPS results in 1 PPS)
• Abandoned Case (1 SPS results in 1 abandoned PPS)
• Group Case with Presentation of Grouped
  Procedures (n SPS results in 1n PPS)

Volume II, Appendix A
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Images Stored
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Images Stored Actors and Transactions
Department
System Scheduler
Image
/ Order Filler
Manager
Performed
Procedure Step
Manager
AcquisitionModality
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Images Stored
Modality or Image Creator
C-STORE (Images Stored)
Image Archive

• Applies to Modality and Image Creator
• Scheduled Procedure Step and Requested Procedure
  information is recorded.

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Storage Commitment
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Storage Commitment Actors and Transactions
Department
System Scheduler
Image
/ Order Filler
Manager
Performed
Procedure Step
Manager
AcquisitionModality
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Storage Commitment

• Modalities and image creators obtain explicit
  agreement from a storage device (i.e. archive,
  etc.) that images (and other objects) will be
  reliably stored
• The duration of storage is defined by the storage
  device product
• Facilitates automated or simplified deletion of
  images on modalities, workstations, etc.

Avoids accidental deletion of images on
modalities and workstations
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Storage Commit. - Push Model
C-STORE operations .
Modality or Image Creator
N-ACTION - (list of referenced image UIDs)
Image Manager
N-EVENT-REPORT - (success or failure)

• Images (or objects) are pushed to storage device
• N-ACTION provides a list of UIDs for objects to
  be reliably stored (may be different AE than
  storage)
• N-EVENT-REPORT confirmation from Storage to
  Modality
• Implementations must design for transactions
  being on multiple associations
• When N-EVENT-REPORT is sent by Storage Device is
  product dependent and may be hours after N-ACTION

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Image Availability Query
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Image Availability Query Actors and Transaction
Department
System Scheduler
Image
/ Order Filler
Manager
Performed
Procedure Step
Manager
AcquisitionModality
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Image Availability Query

• Allows DSS to know when acquired images have
  reached Image Archive and are ready to be
  interpreted
• Minimizes delays in workflow
• MPPS does not guarantee that images were sent to
  the Archive or will ever be
• No notification mechanism in DICOM
• Specialized Query (C-FIND) is defined

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Image Availability Query
C-FIND-RQ (with matching keys)
DSS/ Order Filler
Image Manager
C-FIND-RSP (matches with return keys)

• Instance UID returned in the query response
  signifies availability.
• Storage Location - a system that is a holder of
  images at a particular period in time (AE Title).
• Instance Availability - a period of time for
  images to be moved from a storage location to be
  ready for distribution (OFFLINE,NEARLINE, ONLINE

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Image Query/Retrieve
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Query/Retrieve Actors and Transaction
System Database
Department
System Scheduler
Image
/ Order Filler
Manager
Performed
Procedure Step
Manager
AcquisitionModality
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Query Retrieve of Images
C-FIND-RQ (with matching and return keys)
Image Display
Image Archive
C-FIND-RSP (matches with return keys)

• Defines Matching keys for response filtering by
  Image Archive
• Defines Return keys to be requested by Image
  Display
• Defines Returned attributes by Image Archivein
  query responses
• Defines Returned attributes required to be
  displayed on Image Display

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IHE Generic Keys for Query Retrieve of-
Images- GSPS- SR
R Required by DICOM R IHE-2 Requirement
to be displayed or entered
(SCU), to be returned(SCP)
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Image Specific Query Matching and Return Keys
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Patient Information Reconciliation

• ????????

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?????????

• ????
• ??ID???(?????)
• ????
• ????????
• ?????????????????????
• ???????????????????

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???????

• ???????????????????ID???????????
• ?????????DSS/??????????????????????????

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???????

• ?????????????????ID??????MPPS????
• DSS/??????????????????????????
• ADT???????????ID?????

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???????

• ADT???????????????????????????????????????????????
  ?
• ??????????ADT??????????????????????????
• ?????????????
• ???????????????

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?????

• ????????????????????????????????????????????????
• ???????????????????????
• ADT???????????????????????????????????

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????????

• ??????????ADT?????????????????????????????????????
  ??
• ?????????????????????????????????
• ADT???????????????????????????????????

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?????????????

• ADT???????????????????????? (John Doe, Jane
  Doe)
• ???1 ???????ADT??????????????????????????
• ???2 ???????ADT???????????DSS/????????????
• ???3 ???????ADT???????????????????????????

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?????????????

• ?????????????ID?????????????
• ???4 ??????????ID???????DSS/?????????????????
• ???5 ????ID??????????????????????????(????????ID?
  ???)

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?????? ??? 1
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???/ID??? ???1
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?????? ???2
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???/ID??? ???2
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?????? ???3
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?????? ???3
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?????? ???4
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???/ID??? ???4
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?????? ???5
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???/ID??? ???5
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??????

• ???????? - ADT, ??????, ??????,
  ??????HL7??????????????????
• ?????????ADTA40???????????
• ?????ID?PID-3??????
• ???ID?MRG-1 ??????
• ??ID????????CX?????
• ??ID??????????????????

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??????

• ??????????????DICOM?MPPS?????ID????????????????ID?
  ?????????
• ??????????????ID????????????????
  (???????????????????)
• ???????????????????ID????????

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??????????

• ??????????ADT????????????????????????
• ????????????????ID???????????????
• ???????????ID??????ID??????????????
• ???4?5??? ????????????????????????????????

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Questions?

• Documents Available On the Web at

www.rsna.org/IHE or www.himss.org