november, 2012what ihe delivers xdw (cross-enterprise document workflow) & xber-wd...

November, 2012 What IHE Delivers

Workflow Management for a Referral Process XDW (Cross-Enterprise Document Workflow)XDW (Cross-Enterprise Document Workflow)

&&XBeR-WD (Cross-Enterprise Basic eReferral Workflow XBeR-WD (Cross-Enterprise Basic eReferral Workflow

Definition)Definition)

ftp://ftp.ihe.net/IT_Infrastructure/iheitiyr11-2013-2014/ftp://ftp.ihe.net/IT_Infrastructure/iheitiyr11-2013-2014/Planning_Cmte/EducMaterial/ Planning_Cmte/EducMaterial/

IT Infrastructure Planning Committee

Charles Parisot (GE)

Mauro Zanardini (Arsenàl.IT)

XDW Workflow management infrastructure

Workflow Document in XDW:Workflow Document in XDW:

Specified by XDW is generic across specific workflow contentSpecified by XDW is generic across specific workflow content

Manages workflow specific status with relationship to input/output documentsManages workflow specific status with relationship to input/output documents

Tracking the current/past steps of the workflow and engaged health care entitiesTracking the current/past steps of the workflow and engaged health care entities

XDW technical approach

The detailed description of the technical approach used by XDW:

Educational material:Educational material:ftp://ftp.ihe.net/IT_Infrastructure/ITI_EducationalMaterials/CurrentPublished/IHE-XDW_2012-

03-06.ppt

XDW Content Profile:XDW Content Profile:http://www.ihe.net/Technical_Framework/upload/IHE_ITI_Suppl_XDW.pdf

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OVERVIEW OF THEBASIC REFERRAL

WORKFLOW DEFINITION PROFILE

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XBeR-WD potentialities:

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Flexibility for a wide variety of use-cases:Flexibility for a wide variety of use-cases:

Any health professional involved in the Referral process Any health professional involved in the Referral process can contribute adding information to the clinical process can contribute adding information to the clinical process identifying other actors involved in subsequent steps (e.g. identifying other actors involved in subsequent steps (e.g. Targeted Referral process)Targeted Referral process)

The target of the referral can be a specific clinician or a The target of the referral can be a specific clinician or a Health ServiceHealth Service

The Patient is the center of the clinical process. The The Patient is the center of the clinical process. The patient decisions can affect the evolution of clinical patient decisions can affect the evolution of clinical workflow in accordance with domain policies. workflow in accordance with domain policies.

From the use-case to a Workflow Definition profile

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To define for a Workflow Definition profile:To define for a Workflow Definition profile:

Actors involved: Actors involved: anyany participant with specific role that can participant with specific role that can condition the evolution of the process changing the status of the condition the evolution of the process changing the status of the workflow:workflow:

ParticipantParticipant: an health professional that adds information to the clinical : an health professional that adds information to the clinical processprocess

ActorActor: an health professional that can complete clinical tasks: an health professional that can complete clinical tasks

Workflow tasks: Workflow tasks: a structured action that describes process a structured action that describes process steps in a simple and standardized way steps in a simple and standardized way

Allowed evolutions of the process:Allowed evolutions of the process: any workflow path that any workflow path that can be followed in response to specific triggers.can be followed in response to specific triggers.

Documents produced during the process: Documents produced during the process: clinical information clinical information shared between actors involved shared between actors involved

eReferral Workflow Actors

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Referral RequestedReferral Requested

(COMPLETED)(COMPLETED)


(COMPLETED)(COMPLETED)Referral Referral ReferredReferred


Referral Referral ReferredReferred


Referral Referral ScheduledScheduled


Referral Referral ScheduledScheduled


Referral ReferredReferral Referred

(IN_PROGRESS)(IN_PROGRESS)

Referral ReferredReferral Referred

(IN_PROGRESS)(IN_PROGRESS)

Referral Referral RequesterRequester

Referral Referral RequesterRequester

Referral Referral PerformerPerformer

Referral Referral PerformerPerformer

Referral Referral SchedulerSchedulerReferral Referral

SchedulerScheduler

Workflow Workflow

MonitorMonitor

Workflow Workflow

MonitorMonitor

StartStartStartStart

StopStopStopStop

The Workflow The Workflow Monitor can read Monitor can read the status of the the status of the task at any timetask at any time

Any participant that affects the evolution of the process:Any participant that affects the evolution of the process:GP: GP: acts as acts as Referral Requester, Referral Requester, starting the process with a referral requeststarting the process with a referral request

HCPHCP: acts as : acts as Referral SchedulerReferral Scheduler, scheduling the visit, scheduling the visit

SpecialistSpecialist: acts as : acts as Referral PerformerReferral Performer, starting and completing the visit, starting and completing the visit

Process OversightProcess Oversight: acts as : acts as Workflow MonitorWorkflow Monitor, managing exceptions, managing exceptions

eReferral Process Flow eReferral Process Flow between between Workflow Workflow ActorsActors

eReferral workflow Tasks

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Any simple/complex action performed by an enterprise that needs to be Any simple/complex action performed by an enterprise that needs to be externally “visible”: externally “visible”:

Referral Requested: Referral Requested: a type of task that tracks the request for a referral a type of task that tracks the request for a referral process.process.

Referral Scheduled:Referral Scheduled: a task type that tracks the taking in charge of the a task type that tracks the taking in charge of the eReferral by an HCP.eReferral by an HCP.

Referral Referred: Referral Referred: aa task type that tracks the progress and the completion of task type that tracks the progress and the completion of the referral. the referral.

eReferral process evolution

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Identify events that affects the evolution Identify events that affects the evolution of the process as triggers:of the process as triggers:Completion of Request Completion of Request (Task “Referral (Task “Referral Requested” in status COMPLETED) Requested” in status COMPLETED)

Completion of Scheduling Completion of Scheduling (Task “Referral (Task “Referral Scheduled” in status COMPLETED)Scheduled” in status COMPLETED)

Start of the consultation Start of the consultation (Task “Referral Referred” (Task “Referral Referred” in status IN_PROGRESS)in status IN_PROGRESS)

Completion of the Referral Completion of the Referral (Task “Referral (Task “Referral Referred” in status COMPLETED)Referred” in status COMPLETED)

Documents Referenced

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Any clinical or administrative information conveyed Any clinical or administrative information conveyed between actors involved: between actors involved: eReferral: eReferral: document that describe the referral requested and probably the reason document that describe the referral requested and probably the reason for the requestfor the request

Clinical Input: Clinical Input: clinical information tracked to justify the requestclinical information tracked to justify the request

Exception Report: Exception Report: document produced in case of exception situationdocument produced in case of exception situation

Reminder Note: Reminder Note: document that tracks information reated to the scheduling of document that tracks information reated to the scheduling of the visitthe visit

Clinical Report of the visit: Clinical Report of the visit: document that tracks results of the document that tracks results of the specialist's consultationspecialist's consultation

Label used in XDW

Workflow Document

Example of content

profile

eReferral XDS-SDClinical Report of the Visit

XDS-SD

EDR

PPOC

XD-LAB

ECDR

CIRC

DRPT

APSR

Exception Report XDS-SD

Clinical Input

XDS-SD

PPOC

XD-LAB

ECDR

CIRC

DRPT

APSRReminder Note XDS-SD

Workflow Definition profiles specific features:

Define alternative paths and rules, and suggest the Define alternative paths and rules, and suggest the use of other profiles to define sharing infrastructure use of other profiles to define sharing infrastructure and content of shared documents:and content of shared documents:Workflow Options: Workflow Options: can be selected by a specific project can be selected by a specific project implementation, and allows the profile to be more flexible through implementation, and allows the profile to be more flexible through different local scenarios. different local scenarios. (e.g. the Referral process in a specific implementation (e.g. the Referral process in a specific implementation can evolve without the scheduling phase. In this case a specific option is selected and can evolve without the scheduling phase. In this case a specific option is selected and rules for transition between tasks are changed. Options selected is not an information rules for transition between tasks are changed. Options selected is not an information conveyed between actors but a “foundation” upon which any actor is created inside the conveyed between actors but a “foundation” upon which any actor is created inside the specific project implementation)specific project implementation)

Grouping of actors: Grouping of actors: used to require: used to require:

Specific document sharing infrastructures Specific document sharing infrastructures (e.g. XDW, XDS, XDM, XDR)(e.g. XDW, XDS, XDM, XDR)

Including referenced content in standardized way Including referenced content in standardized way (e.g. XDS-SD, XD-LAB, XDS-I, (e.g. XDS-SD, XD-LAB, XDS-I, XPHR, XDS-MS) XPHR, XDS-MS)

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1) Referral Request (1/2)

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The GP’s software, as The GP’s software, as Referral RequesterReferral Requester, produces the , produces the eReferraleReferral Document and the related Workflow Document characterized by:Document and the related Workflow Document characterized by:

WorkflowDefinitionReference= WorkflowDefinitionReference= 1.3.6.1.4.1.19376.1.5.3.1.5.11.3.6.1.4.1.19376.1.5.3.1.5.1

WorkflowStatus=OPENWorkflowStatus=OPEN

Only one task “Referral Referred” Only one task “Referral Referred” created in status COMPLETEDcreated in status COMPLETED

This “eReferral” document is This “eReferral” document is attached to the Workflow Documentattached to the Workflow Document

eReferral DoceReferral Doc

Workflow Workflow DocumentDocumentWorkflow Workflow DocumentDocument


Input: --Input: --Output: Output: eReferral doceReferral doc


Input: --Input: --Output: Output: eReferral doceReferral doc

COMPLETEDCOMPLETED

1) Referral Request (2/2)

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eReferral eReferral documentdocumenteReferral eReferral documentdocument

Workflow Workflow Document Document Ver.1Ver.1APPROVEDAPPROVED


XDS infrastructureXDS infrastructureXDS infrastructureXDS infrastructure

Documents produced are submitted to Documents produced are submitted to the XDS Infrastructurethe XDS Infrastructure

The eReferral document is now available, along with its related status The eReferral document is now available, along with its related status tracked by the Workflow Document, to all organizations tracked by the Workflow Document, to all organizations

2) Scheduling the Referral (1/2)

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The patient calls for appointment. Administrative person on Hospital System, as The patient calls for appointment. Administrative person on Hospital System, as Referral SchedulerReferral Scheduler, checks the status of the eReferral workflow by consuming the , checks the status of the eReferral workflow by consuming the Workflow Document : Workflow Document :

Visit needs to be scheduled (task “Referral Requested” status COMPLETED) Visit needs to be scheduled (task “Referral Requested” status COMPLETED)

Use the “eReferral” Use the “eReferral” document as inputdocument as input

Set appointment (producing Set appointment (producing “Reminder Note” “Reminder Note” for patient)for patient)

Add a new task “Referral Scheduled” in status COMPLETEDAdd a new task “Referral Scheduled” in status COMPLETED

Updates the Workflow DocumentUpdates the Workflow Document

Workflow Workflow DocumentDocumentWorkflow Workflow DocumentDocument

Referral RequestedReferral RequestedReferral RequestedReferral Requested

COMPLETEDCOMPLETED

Referral ScheduledReferral ScheduledInput: Input: eReferral doceReferral doc

Output: Output: Reminder NoteReminder Note

Referral ScheduledReferral ScheduledInput: Input: eReferral doceReferral doc

Output: Output: Reminder NoteReminder Note

COMPLETEDCOMPLETED

Reminder Reminder NoteNote

Reminder Reminder NoteNote

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Workflow Workflow Document Document Ver.1Ver.1DEPRECATEDDEPRECATED




The visit can be cancelled by an administrative person, changing the The visit can be cancelled by an administrative person, changing the status of the task “Referral Scheduled” to:status of the task “Referral Scheduled” to:

IN_PROGRESS: needs to re-schedule the visit (same Provider)IN_PROGRESS: needs to re-schedule the visit (same Provider)

FAILED: eReferral is released by the Health Care ProviderFAILED: eReferral is released by the Health Care Provider

Reminder Reminder NoteNoteReminder Reminder NoteNote

2) Scheduling the Referral (2/2)2) Scheduling the Referral (2/2)

3) Start of the consultation (1/2)

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The patient visits the specialist. The specialist’s software, as The patient visits the specialist. The specialist’s software, as Referral Referral PerformerPerformer, checks the status of the workflow. , checks the status of the workflow.

By consuming the Workflow Document

Sees that the visit has been scheduled (task “Referral Scheduled” in status COMPLETED)

Reviews the eReferral document related.

Referral Performer starts the visit process updating the Workflow Document

Adding a new task “Referral Referred” in status IN_PROGRESS

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Workflow DocumentWorkflow DocumentWorkflow DocumentWorkflow Document


COMPLETEDCOMPLETED

Referral ScheduledReferral ScheduledReferral ScheduledReferral Scheduled

COMPLETEDCOMPLETED

Referral ReferredReferral ReferredInput: Input: eReferral doceReferral doc

Output: Output: ----


Output: Output: ----

IN_PROGRESSIN_PROGRESSIN_PROGRESSIN_PROGRESS

The visit process is in execution.The visit process is in execution.

eReferral eReferral documentdocumenteReferral eReferral documentdocumentWorkflow Workflow

Document Document Ver.1Ver.1DEPRECATEDDEPRECATED






3) Start of the consultation (2/2)3) Start of the consultation (2/2)

Workflow DocumentWorkflow DocumentWorkflow DocumentWorkflow Document

4) End of the consultation (1/2)

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The specialist’s software, as The specialist’s software, as Referral PerformerReferral Performer, completes the visit , completes the visit process producing the “Clinical Report Of The Visit” and closes the process producing the “Clinical Report Of The Visit” and closes the Referral process completing the Referral Referred task:Referral process completing the Referral Referred task:

Set the task “Referral Referred” status to Set the task “Referral Referred” status to COMPLETEDCOMPLETED

Close the workflow by setting the Close the workflow by setting the WorkflowStatus to CLOSEDWorkflowStatus to CLOSED

Reference the “Clinical Report of the Visit” Reference the “Clinical Report of the Visit” document as output of the Referral Referred taskdocument as output of the Referral Referred task

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COMPLETEDCOMPLETED

Referral ScheduledReferral ScheduledReferral ScheduledReferral Scheduled

COMPLETEDCOMPLETED


Output: Output: Clinical Report of Clinical Report of the visitthe visit


Output: Output: Clinical Report of Clinical Report of the visitthe visit

IN_PROGRESSIN_PROGRESSIN_PROGRESSIN_PROGRESS

COMPLETEDCOMPLETED

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Workflow Workflow Document Document Ver.2Ver.2DEPRECATEDDEPRECATED Clinical Clinical

Report of Report of the Visitthe Visit





The Referral process is completedThe Referral process is completed

The Referral Requester actor can be notified for the publication The Referral Requester actor can be notified for the publication of the Report of the Report (e.g. using a DSUB notification system) (e.g. using a DSUB notification system)

4) End of the consultation (2/2)

XDW e XBeR-WD references

XDW supplement:XDW supplement:Trial Implementation statusGood feedbacks for the first testing session in EU ConnectathonFirst testing planned for US Connectathon - Jan 2013

XBeR-WD supplement:XBeR-WD supplement:Trial Implementation statusFirst product announced at RSNA December 2012Adoption is strictly related to XDW dissemination

november, 2012what ihe delivers xdw (cross-enterprise document workflow) & xber-wd...

Documents

referral task referral

referral scheduler

referral requesthcp

referral performer

referral requester

evolution of clinical

consultation task referral

process steps