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The following requirements help frame the need for standardization to support Foreign Exam Management.  They assume integration between local RIS / PACS and a shared DI-R already exists.

UC-1 Workflow

The focus of FEM use cases is acquisition (“fetching”) of relevant foreign exams for display and use by health care providers during the course of a current patient encounter.  Image sets can be very large and therefore the ability to “pre-fetch” images before they are required for viewing is desired to improve user productivity. 

The XDS Affinity Domain Implementation Guide identifies a number of use cases which are summarized here:

UC-1.1 Pre-Fetching

• • Patient related events at the local facility trigger an automatic search for relevant prior exams on the DI-R:
    • Basic example: request related prior images when an exam is ordered, initiate query on patient arrival to radiology,
    • Non-radiology example: patient arrival at clinic (e.g. oncology, neurology) triggers search for relevant exams, or
    • Report only example: similar to examples above but return reports only.
  • Relevant image sets and reports are automatically retrieved and brought in to the local hospital system for review.
  • Information retrieved should not be archived locally as it remains available from the DIR.

UC-1.2 Ad-Hoc or On-Demand Image Fetch

• • A user at the local facility manually initiates a query to find existing relevant prior images for a specified patient and selects image sets of interest from a list of results.
  • Relevant image sets and reports are retrieved and brought in to the local hospital system for review.
  • Information retrieved should not be archived locally as it remains available from the DIR.

UC-1.3 Amendments

• • Identifies steps to replace foreign report when a report is amended after pre-fetch.
  • Identifies steps to replace an image set when an image is added or changed after pre-fetch.

UC-1.4 Emergency Patients

• • Identifies options to use DI-R / FEM to improve workflow when patient arrives at hospital via ambulance.

UC-2 Identification of Relevant Prior Exams

Fetching or pre-fetching of relevant information requires consistent use of metadata to determine relevance.

• Identifiers used to specify the acquisition modality and anatomic region of the study need to be standardized.

UC-3 Retention of Foreign Information

Foreign content should be identifiable within local systems and should not be archived or retained long term.