Cleveland Clinic Foundation

User Success Story
Cleveland Clinic Foundation
Scheduled Workflow and Patient Information
Reconciliation
Contacts
David Piraino, M.D, Section Head – Radiology Informatics
Michael T. Modic, M.D, Head of Radiology
IHE Integration Profiles, Actors and Transactions Implemented
Integration
Profile
System/vendor
IHE Actor(s)
IHE Transactions
New or
upgrade?
Institution
The Cleveland Clinic Foundation’s main campus is located in
Cleveland, Ohio. The Division of Radiology of this 954-bed hospital, headed by Michael T. Modic, M.D., offers a full spectrum of
radiological services. Each year over 800,000 examinations are
performed and interpreted by Cleveland Clinic radiologists. The
Section of Radiology Informatics, headed by David Piraino, M.D, maintains the radiology information system IDXRad and more than 80 imaging modalities from different vendors.
Scheduled
Workflow
HIS
IDX Last Word
Siemens Invision
ADT
Order Placer
Patient Registration
Patient Update
Placer Order Management
Filler Order Management
Since 1998
IDX IDXrad v10
Order Filler
Patient Registration
Since 2000
Patient Update
Placer Order Management
Filler Order Management
Procedure Scheduled
Modality Worklist Provided
Modality PPS in Progress
Modality PPS Completed
Image Availability Query
Creator Procedure Step in Progress
Creator Procedure Step Completed
IDX Imaging
Suite v10
Image Manager
Procedure Scheduled
Modality PPS in Progress
Modality PPS Completed
Storage Commitment
Image Availability Query
Query Images
Retrieve Images
Since 2000
IDX Imaging
Suite v10
Perform Procedure
Step Manager
Procedure Update
Patient Update
Modality PPS in Progress
Modality PPS Completed
New
4th Quarter
2002
Siemens CTs
2 x SOMATOM
Volume Zoom
(VA40)
Acquisition
Modality
Modality Worklist Provided
Modality PPS in Progress
Modality PPS Completed
Modality Images Stored
Storage Commitment
Upgrade
Overview
In order to provide better patient care and provide an efficient operational workflow, the Cleveland
Clinic Foundation has implemented the “Scheduled Workflow” and “Patient Information
Reconciliation” integration profiles. These transactions are supported and in production at the
Cleveland Clinic.
The HL7 ADT Patient Registration and Update, Filler and Order Management transactions are sent
from various HIS systems to the IDXrad RIS. The transactions “Modality Worklist Provided” and
“Modality Images Stored” are in use in the CT department at the Cleveland Clinic. With the recent
update of the Siemens CT Scanners these imaging modalities now support the transactions
“Modality PPS in Progress”, “Modality PPS Completed” and “Storage Commitment”. With the
exception of “Storage Commitment”, the IDXrad RIS also supports these transactions.
Clinical/Integration Problem Addressed
The Cleveland Clinic Foundation implementation is an ongoing process to implement IHE
Integration Profiles. The first integration profiles chosen were “Scheduled Workflow” and “Patient
Information Reconciliation”.
The patient demographics and exam information being sent from the HIS to the RIS (ADT/Order
Placer and Order Filler) has been in place for the past 4 years. Implementation of Modality
Worklist has been an ongoing process for the past 3 years and is currently approaching 100 integrated modalities. Currently, Storage Commitment and Modality Perform
Procedure Step are in their initial implementation stage.
Prior to these implementations, the process was very paper-based and there was a
great amount of data entry required. Much of the same information was being
entered into different systems – the HIS, the RIS, the PACS and the Modality. This
slowed down the operational workflow.
1 x SOMATOM
Emotion (VA40)
Upgrade
1 x SOMATOM
Emotion Duo (VA40)
Upgrade
1 x SOMATOM
Sensation 16 (VA50)
New
Siemens PACS/
Sienet
Image Manager
Image Archive
Procedure Scheduled
Modality Images Stored
Storage Commitment
Upgrade
Integration
Profile
System/vendor
IHE Actor(s)
IHE Transactions
New or
upgrade?
Patient
Information
Reconciliation
HIS
IDX Last Word
Siemens Invision
ADT
Order Placer
Patient Registration
Patient Update
Placer Order Management
Filler Order Management
Since 1998
IDX IDXrad v10
Order Filler
Patient Registration
Since 2000
Patient Update
Procedure Update
Placer Order Management
Filler Order Mgmt
Procedure Scheduled
Modality Worklist Provided
Modality PPS in Progress
Modality PPS Completed
Image Availability Query
IDX Imaging
Suite v10
Image Manager
Procedure Scheduled
Patient Update
Procedure Update
Modality PPS in Progress
Modality PPS Completed
Storage Commitment
Image Availability Query
Since 2000
IDX Imaging
Suite v10
Perform Procedure
Step Manager
Modality PPS in Progress
Modality PPS Completed
New 4th
Quarter 2002
Siemens CTs
2 x SOMATOM
Volume Zoom
(VA40)
Acquisition
Modality
Modality Worklist Provided Upgrade
Modality PPS in Progress
Modality PPS Completed
Modality Images Stored
Storage Commitment
Upgrade
By using the IHE Technical Framework as a guideline, much of the mapping exercises
were shortened as it provided a common understanding and language between all
the different information system, imaging system, and modality vendors.
Implementation Issues Encountered
The challenge of managing each vendor’s update to their software was overcome by creating a
fully-functional test environment. This approach enables Cleveland Clinic to effectively simulate
their production environment. Following a controlled change management process, each vendor
installs their latest update into the test environment. Extensive testing occurs until all vendors
and Cleveland Clinic approve the update; then it is scheduled to be placed into production.
Also important was managing the business processes and workflow changes that these integrated
solutions brought to the Cleveland Clinic. Business process re-engineering requires an intense
user education process which includes user feedback. For successful integration, it is critical to
work closely with all users of the solution.
Benefits Achieved
The main benefits achieved by implementing the IHE profile at CCF are:
• time savings during patient registration (due to use of MWL)
• elimination or at least significant reduction of errors during patient registration (due to use of MWL)
• elimination of manual input at RIS terminal (due to use of MPPS)
• elimination of manual check of archiving the images (due to use of Storage Commitment)
• reduction of incorrectly identified or “lost” studies
1 x SOMATOM
Emotion (VA40)
1 x SOMATOM
Emotion Duo (VA40)
Upgrade
1 x SOMATOM
Sensation 16 (VA50)
New
Siemens PACS/
Sienet
Image Manager
Image Archive
Procedure Scheduled
Patient Update
Procedure Update
Modality Images Stored
Storage Commitment
Upgrade