information from MWL orders to carry over to completed study

[Matt]

Hello,

I am working with some people to set up digital X-Rays and MWL using an EMR, dcm4chee 2.x and a single X-Ray modaltiy at a small hospital. So far things have been going fairly well considering we don't have a lot of training and experience in this area. But I have a question:

My plan for using MWL has been that:

• orders are generated in the EMR and get an order number and patient ID from the EMR
  
• HL7 is used to send the order information to dcm4chee
  
• dcm4chee uses the current time and order number to generate a unique study uuid for the order (in orm2dcm.xsl)
  
• a modality (Carestream DRX1) fulfills the worklist orders, generating PACS images with matching patient ID and study uuid. The X-Ray technician specifies an accession number, not related to EMR.
  
• the EMR may retrieve these images from dcm4chee by querying by patient id or by date
  
• the EMR matches studies from dcm4chee against corresponding orders, using the order number.

My hope was that at order time the order number could be included in the MWL order in dcm4chee, and would carry over to the completed PACS study. The issue is that I don't know how to keep the order number to carry over. I tried putting this info in (0040,2016) Placer Order Number, but this tag doesn't get set on the fulfilled X-Ray image.

For now I've been extracting the order number from the studyuuid on fulfilled orders, but this feels like a hack. Is there a way to know what information will carry over from order to fulfilled X-Ray image? Is that up to the carestream modality or can dcm4chee do something like this?

[fleetwoodfc]

You can configure the storescp to query the MWL and coerce the incoming image objects with the MWL SPS and RP information. 

This is done using two xsl files - cstorerq2mwl-cfindrq.xsl and mwl-cfindrsp2cstorerq.xsl. There are samples provided in the conf/dcm4chee-ae and conf/dcm4chee-ae/MOD_AET folders.

p.s. If you are creating new study UIDs then you should have your own assigned Study UID root.    

[Gunter Zeilinger]

Is there any good reason, why the Accession Number is entered by the technician and not taken from the Worklist?! Typically, non-DICOM aware IS systems uses the Accession Number to find the ordered Study in the PACS. If the Filler or Placer Order Number does not exceeds 16 characters, you may just use one of them as Accession Number.

gunter

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[Matthew Gibson]

In the past, the accession number has been assigned at the modality itself, and this is something I wanted to keep in order to make X-Ray organization a bit more robust to technical issues in the future. If the accession number doesn't depend on the PACS / EMR, then if unexpected things happen in the future, such as the PACS or EMR system going down when there is no IT technician present, x-rays can still be taken and have some basic organization for future reference.

So for each x-ray an entry is entered by hand in a notebook by the modality itself, with patient name and accession number.

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[Gunter Zeilinger]

See IHE SWF, how unscheduled/emergency cases shall be handled. In short, if there is no request, there should not be an Accession Number in the object stored from the modality.

[Matthew Gibson]

Thanks, your comments have been helpful. We'll be meeting with some of the main doctors in the next while to make some decisions regarding these processes.