- Under Development
- Draft For Use
- Implemented
- Retired
June, 2015
RECOMMENDED FOR USE
Key Contributors
| Name | Title | Organization | Contact Information |
|---|---|---|---|
Purpose
This guide provides an overview of available standards and a recommended approach to support the Foreign Exam Management requirements as identified below. The intent is to simplify standards selection decisions in future projects and, in turn, to promote standardization of solutions across projects by providing useful information to support decision making in a readily consumable format.
Content in this guide was summarized from the Canadian XDS Affinity Domain Implementation Guide v1.1 20140527 to provide an accessible overview of the standards selected to support the listed Use Cases.
Business Context
The Foreign Exam Management (FEM) use cases in this Guide relate to a subset Diagnostic Imaging related document sharing requirements which were addressed by the XDS Affinity domain and which are summarized in the XDS Affinity Domain Implementation Guide.
Foreign Exam Management (FEM) relates to those scenarios where a health care provider organization with local Radiology Information System (RIS) and Picture Archiving and Communication System (PACS) needs to allow users to retrieve and view an “imaging exam that was ordered, acquired, and reported on at some site external to the one where the study is currently being imported.” (IHE IRWF Supplement for Trial Implementation)
Although existing systems provide the means to import Foreign Exams from external sources manually, the integration of local systems with shared Diagnostic Imaging Repositories (DI-R) introduces new workflows and requirements in need of standardization, including:
- Automated import (fetching) of prior exams, and
- Rules for local management of content which is maintained within and readily available from alternate source systems.
Typical Use Cases
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 DI-R.
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 DI-R.
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.
Evaluated Standards & Recommended Approach