IHE Scheduled Workflow - what happens with images when an order is cancelled? - DICOM

This is a discussion on IHE Scheduled Workflow - what happens with images when an order is cancelled? - DICOM ; Hi there, This is more a question for IHE but I wanted to start here before I go to the technical committee for IHE Radiology. I have a situation where we have images attached to an order (procedure) and suddenly ...

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Thread: IHE Scheduled Workflow - what happens with images when an order is cancelled?

  1. IHE Scheduled Workflow - what happens with images when an order is cancelled?

    Hi there,

    This is more a question for IHE but I wanted to start here before I go
    to the technical committee for IHE Radiology.

    I have a situation where we have images attached to an order
    (procedure) and suddenly the RIS sends me a cancellation message (ORM)
    for that procedure. On top of that, they want to re-use that accession
    number and visit number for another patient. Is this legal? What am I
    (PACS) supposed to do when I receive a cancellation message from the
    RIS? Do I remove that whole record? How about the images attached to
    that procedure?

    Any ideas will be greatly appreciated,

    -Anibal


  2. Re: IHE Scheduled Workflow - what happens with images when an order is cancelled?

    On Mar 21, 5:55 am, "Anibal Jodorcovsky" wrote:
    > Hi there,
    >
    > This is more a question for IHE but I wanted to start here before I go
    > to the technical committee for IHE Radiology.
    >
    > I have a situation where we have images attached to an order
    > (procedure) and suddenly the RIS sends me a cancellation message (ORM)
    > for that procedure. On top of that, they want to re-use that accession
    > number and visit number for another patient. Is this legal? What am I
    > (PACS) supposed to do when I receive a cancellation message from the
    > RIS? Do I remove that whole record? How about the images attached to
    > that procedure?
    >
    > Any ideas will be greatly appreciated,
    >
    > -Anibal


    You can create a recycle table to reserve the information you remove
    from the regular table.


  3. Re: IHE Scheduled Workflow - what happens with images when an orderis cancelled?

    Hi Anibal,

    > I have a situation where we have images attached to an order
    > (procedure) and suddenly the RIS sends me a cancellation message (ORM)
    > for that procedure. On top of that, they want to re-use that accession
    > number and visit number for another patient. Is this legal? What am I
    > (PACS) supposed to do when I receive a cancellation message from the
    > RIS? Do I remove that whole record? How about the images attached to
    > that procedure?


    interesting case. I don't think that the IHE TF contains explicit information for this case.
    My impression is that this situation should never occur in the first place. First of all,
    cancelling an order while the patient is already undergoing examination sounds like human
    error to me. Secondly, if you have already created images, then you also have already
    initiated an MPPS "IN PROGRESS", and that should also prevent the RIS from cancelling
    the order. Thirdly, re-using an accession number is a very stupid idea. Re-using an
    identifier will always get you in trouble at some point in time, as your example shows.
    The accession number in DICOM can have about 4.4E31 different values, i.e. you can manage
    more than 10^21 procedure steps for each living human being without ever reusing any accession
    number. I really don't see the point in re-using accession numbers.
    The visit number on the other hand should not be a problem because there may be
    multiple accession numbers for one visit anyway.

    Regards,
    Marco Eichelberg
    OFFIS



  4. Re: IHE Scheduled Workflow - what happens with images when an order is cancelled?

    I agree with Marco that re-using Accession Number is a terrible
    idea ... do not do this.

    Also, it is very likely inappropriate to delete the images, though you
    may want to hide them from general view ... if the patient has been
    exposed to ionizing radiation in the course of obtaining these images
    (even if unwanted), there are very likely legal requirements that
    require them to be retained +/- a report generated for them (even if
    the radiologist will not be paid because the order was cancelled). But
    that is a policy, not a DICOM or IHE issue.

    David


  5. Re: IHE Scheduled Workflow - what happens with images when an order is cancelled?

    I cannot agree more: re-using the Accession Number sounds like a pure
    masochistic idea that only software people can have (I'm in the number
    by the way and have some brilliant ideas like this sometimes too...),
    although I seem to understand that this was not your choice.
    Anyway, I would like to draw the attention on the IHE-TF, which
    actually deals in part with the problem.
    Quoting from TF-RAD 6.0:
    1) vol II section 4.2.4.2.3 Expected Actions:
    "....Order Placer shall not cancel order that has already been
    started, i.e., the one for which Order Filler transmitted the "In-
    Progress" status (see sec. 4.3.4.2). However, if the Order Filler
    receives the cancellation message after it has sent the Status Update
    message (for example, in a case of a race condition between two
    messages), Order Filler shall accept order cancellation and perform
    Transaction RAD-13 Procedure Update to notify Image Manager.
    It is expected that in most cases Order Placer will utilize the ORM
    message with the control code of CA. However, in some cases (such as
    with recurring orders - to stop the order fulfillment before all its
    parts were completed), Order Placer and Order Filler may agree on a
    use of the ORM message with the control code DC. Upon receiving such
    ORM message, DSS/Order Filler shall perform Transaction RAD-13
    Procedure Update (see sec. 4.13) to notify the Image Manager of order
    discontinuation."

    So this CAN happen and there is a special status ("discontinued") in
    HL7 that fits to the case where the procedure is already started.
    Unfortunately, the IHE-TF does not specify what to do with already
    generated images in this case, see 4.13.4.3 Expected Actions:
    "... DC - Order to which the particular procedure is related, has been
    discontinued after at least one Performed Procedure Step for this
    procedure has started. The Image Manager and the Report Manager shall
    consider all remaining SPS known for that procedure (if any)
    cancelled. The Image Manager shall use the Study Instance UID as a
    unique key of the procedure in question. Information from PID and PV1
    segments shall not be used to update patient information."

    There is one interesting sentence here, "The Image Manager shall use
    the Study Instance UID as a unique key of the procedure in question"
    that can be important, I hope that the Study Instance UID will not be
    "reused" by the RIS !!

    Hope this helps,
    Andrea Spada


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