Recording additional Use Cases for FEM - deferred for now

Hello DI Community-

The purpose of this post is to document the non-priors use cases which are to be excluded from the Aug 2017 submission for Foreign Exam Management IHE new profile proposal. The plan/consensus from the 5/19/2017 call is that FEM Priors in XDS environment and FEM Priors in DICOM environment (aka Use Cases 1 and 2) will be put forth as the 2017 FEM profile proposal. Next January or so, this group will reconsider the other 3 use cases (remote read, ED Transfer, and Remote Consult esp oncology) to be proposed either as a Named Option to FEM or as a new profile proposal.

Additional Documentation on Use Cases 3-5 here for the sake of persistence:

X.4.2.3 Use Case 3: Imaging and Reporting performed in separate facilities

IHE FEM Use Case 3 - Study Read at different facility

Pseudocode for Use Case 3 WebSequence Diagram:

title FEM Use Case 3: Imaging and Reporting in separate facilities

participant DSS/OF
participant Modality
participant Image Manager
participant Static Rules
participant Foreign Exam Manager
participant PIX Mgr
participant Remote Image Manager
participant Remote Report Manager
participant 3rd Remote IM
participant 3rd Remote RM
participant 3rd Remote IM
participant 3rd Remote RM



DSS/OF->Image Manager: Procedure Scheduled [RAD-4]
activate DSS/OF
DSS/OF->Reading Worklist Manager: Procedure Scheduled [RAD-4]
DSS/OF->Foreign Exam Manager: Procedure Scheduled [RAD-4]
Modality->DSS/OF: DICOM Modality\n Worklist [RAD-5]
deactivate DSS/OF

Modality->Modality: new imaging study
Modality->Image Manager: Send new study\n Send Images [RAD-8]

Reading Worklist Manager->Reading Worklist Manager: Business logic determines\n remote reporting required

Reading Worklist Manager->Foreign Exam Manager: Create FEM-specific Order\n (HL7 v2 ORM)
activate Foreign Exam Manager
Foreign Exam Manager->Image Manager: DICOM Query for new study images\n (get study to be read)
Foreign Exam Manager->Foreign Exam Manager: DICOM tag morph new study\n to local values
Foreign Exam Manager->Remote Image Manager: Send new study- tag morphed\n Send Images [RAD-8]
deactivate Foreign Exam Manager


Foreign Exam Manager->Foreign Exam Manager: determine if patient has been seen elsewhere
activate Foreign Exam Manager
Foreign Exam Manager->PIX Mgr: PIX Query [ITI-9]
Foreign Exam Manager->3rd Remote IM: DICOM Query [RAD-xx]
Foreign Exam Manager->Foreign Exam Manager: determine relevance of priors, if applicable\n DICOM tag morph to local values


3rd Remote RM-> Foreign Exam Manager: Store (Prior) Reports over time [RAD-Y1] (ORU, CDA)



Foreign Exam Manager->Foreign Exam Manager: HL7 tag morph\n to local values
Foreign Exam Manager->Foreign Exam Manager: convert report format,\n if necessary\n (e.g., HL7 v2 ORU/CDA to DICOM SC)


Foreign Exam Manager->Remote Image Manager: Store (Prior) Images [RAD-8]\n (include report as SC, if configured)
Foreign Exam Manager->Remote Report Manager: Store (Prior) Reports over time [RAD-Y1] (ORU, CDA)
deactivate Foreign Exam Manager

note over Foreign Exam Manager, Remote Report Manager: time passes
Remote Image Manager->Remote Image Manager: purge prior images, but not study just read??
Remote Report Manager->Remote Report Manager: purge prior reports, but not newly created report


Use Case 4:



X.4.2.4.1 Emergency patient transfer - Use Case Description
<Describe the key use cases addressed by the Profile. Limit to a maximum of one page of text or consider an appendix.>

From Cezary’s email: To your question: the use case I was talking about had to with patient transfers, usually in the context of an emergency. For example, a trauma patient is brought to Hospital A; after 20 minutes during which an imaging study has been acquired and viewed by the emergency physician, the patient is moved to Hospital B which is better suited to deal with this emergency. Before the study has been officially reported by the radiologist in Hospital A (may not happen until next day), a decision is made to transfer the emergency patient to Hospital B. While the patient is in the ambulance on their way to Hospital B, the acquired imaging study - which is not technically a prior as it has not even been read by the radiologist -- is sent to Hospital B.

As you can see from the example above, we are not really fetching priors here but rather currents (from Hospital A to Hospital , so calling it "fetching priors" would be a misnomer. Note that this is different from the remote read use case too as the intent is not to read the study in Hospital B (it was acquired and will be eventually read by Hospital A, which will also bill for it).

From David Koff: Neonatal example of transfer/implications
Took xray of line
KW- could not open CD; could not access DIR
Line not in correct place
Severity of not being able to access xray

IHE FEM Use Case 4 - ED Transfer

Pseudocode for Use Case 4 WebSequence Diagram:

title FEM Use Case 4: ED Transfer to Tertiary Facility (DICOM and HL7 v2)

participant DSS/OF
participant Modality
participant Image Manager
participant Report Manager
participant Foreign Exam Manager
participant PIX Mgr
participant Remote Image Manager
participant Remote Report Manager



DSS/OF->Image Manager: Patient Transfer A02/A12 [ITI PAM]
activate DSS/OF
DSS/OF->Report Manager: Patient Transfer A02/A12 [ITI PAM]
DSS/OF->Foreign Exam Manager: Patient Transfer A02/A12 [ITI PAM]

deactivate DSS/OF

Report Manager->Foreign Exam Manager: All reports are sent to FEM Mgr for storage\n [FUNC RAD-Y1]


Foreign Exam Manager->PIX Mgr: PIX Query [ITI-9]\n (what if the patient is not\n registered at the tertiary site?)
activate Foreign Exam Manager
Foreign Exam Manager->Image Manager: Query for Images (DICOM) [RAD-14]
Foreign Exam Manager->Foreign Exam Manager: determine current study (and priors?),\n using internal business logic
Foreign Exam Manager->Image Manager: Retrieve Images [RAD-14]\n (relevant prior studies)

Foreign Exam Manager->Foreign Exam Manager: HL7 and DICOM tag morph\n to local values
Foreign Exam Manager->Foreign Exam Manager: convert report format, if necessary\n (e.g., HL7 v2 ORU/CDA to DICOM SC/SR)

Foreign Exam Manager->Remote Report Manager: Procedure Scheduled [RAD-4]\n (prep for prior report)
Foreign Exam Manager->Remote Report Manager: Store Report [RAD-Y1]\n (if HL7 ORU text or CDA)

Foreign Exam Manager->Remote Image Manager: Procedure Scheduled [RAD-4]\n (prep for NEW study (and priors?))
Foreign Exam Manager->Remote Image Manager: Store Images [RAD-8]\n (include report as SC/SR, if configured)
deactivate Foreign Exam Manager



note over Image Manager, Report Manager: what if the study is interpreted later? send report?


note over Image Manager, Report Manager: time passes
Remote Image Manager->Remote Image Manager: purge?? prior study images
Remote Report Manager->Remote Report Manager: purge?? prior study reports


X.4.2.5 Use Case 5: Remote Consult (report may or may not exist)
-network in existence.
-must include priors, esp for oncology

(Use Case 5 not developed beyond this...)