Management and presentation of grouped procedures: has the IHE integration profile cracked the toughest radiology workflow nut?

In a simple, typical radiology workflow process, an order generates a single procedure, which in turn generates a single data set, from which, one radiology report is generated. There are, however, occasions when a single order consists of more than one procedure each with a separate report, yet the procedures are accomplished by one physical acquisition of data. The prototypical example of this is the request for computed tomographic evaluation of the chest, abdomen and pelvis. The study is accomplished, with modern day scanners, by a single helical acquisition, yet there are typically three codable and billable procedures involved, and these may be reported independently either for administrative or academic reasons. This grouping of procedures remained up to now a challenge to automate across integrated modalities, PACS and RIS. This paper discusses a number of other practical cases where this situation occurs and reviews the capabilities of the Presentation of Grouped Procedures IHE Integration Profile in solving this problem. The DICOM services used are evaluated as well as the strengths and weaknesses of this IHE Integration Profile. The implementation experience gained on both a CT and an MR for the IHE Demonstration at RSNA 2000 and HIMSS 2001 is also reviewed. In conclusion, the resulting clinical and operational benefits are discussed.