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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.

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:

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.

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.

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.

Emergency Patients

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

Identification of Relevant Prior Exams

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

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

Retention of Foreign Information

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