Let's face it, IT speak isn't something we learned in medical school. There are a lot of terms that are unfamiliar to physicians when talking about imaging workflows. Moreover, many terms are acronyms that are thrown around like candy at Halloween. The first step to understand an imaging workflow is to understand these terms. Below are two resources that are excellent starting points to understand these basic terms and their definitions. 

"Understanding IT Speak 101" by Rob Ferre and Dave Hennon

"IT Basics and Definition of Terms" by Rob Ferre and Christian Dameff

There are two types of imaging workflows. The traditional imaging workflow is called an "Order Based Workflow." This workflow begins when an order is placed to begin the workflow process, hence the name. This workflow has been around for decades and is how radiologic studies go from an order to an imaging study that has an interpretation and a link that allows the image to be viewed within the electronic medical record (EMR). 

The second type of imaging workflow is called an "Encounter Based Workflow." This workflow begins when an image is obtained as part of a visit within a healthcare facility. Images are obtained by physicians as part of a procedure (e.g. colonoscopy) and archiving those images with an attached report is needed. In order to get these images into a long term storage solution (e.g. PACS) with an attached report within the EMR, certain requirements are needed. These are accomlished using an encounter based workflow.

To learn more about the differences between an order and an encounter based workflow, including a flow diagram, click here. 

In September 2021, a survey was conducted about workflow preferences for emergency ultrasound workflows. There was strong consensus surrounding four items by emergency ultrasond experts who completed the survey. These included the following:

1. An encounter-based workflow was desired over an order-based workflow

2. A simplified solution to quickly entering patient data was needed (e.g. barcode scanner) 

3. Remote login function to the workflow system was essential

4. Emergency ultrasound experts wanted the ability to customize their own worksheets based on their local needs

To access a presentation on the data, click here or you can access this from "The Data" tab on the top of this page. 

In 2020, a workflow process map was created through the ACEP Emergency Ultrasound Section's Industry Roundtable that mapped out the process of an encounter based workflow from the perspective of an Emergency Ultrasound Director. The map provides detailed insights into the POCUS workflow process and potential areas for design improvement. This map is available here.

In 2022, a collaborative group of emergency physicians, informaticists, and representatives from both the ultrasound and electronic health record industry formed a work group to examine and create best practice standards around POCUS workflows. The purpose of this work group was to examine current workflow processes and published IHE profiles with respect to POCUS workflows and to optimize or propose new industry standards. 

Background Documents: The following have been published regarding POCUS workflows:

• IHE Encounter Based Imaging Workflow Profile. This describes an encounter based workflow profile where images need to be stored in a vendor neutral archive and displayed within an electronic health record. One of the use cases in this profile includes POCUS (page 47). 

• IHE PowerPoint on Encounter Based Imaging Workflow. This provides a summary overview of the encounter based workflow as developed. 

• ACEP IRT "Emergency Ultrasound: Workflow White Paper". This paper describes workflow requirements for documenting POCUS exams within the electronic health record.

Work Group Documents: The following documents have been presented as part of the workflow work group meetings

• PowerPoint presentation on the "Overview of IHE EBIW Profile and Processes" by Steve Nichols

• IHE EBIW FHIR Draft Document

Workflow Presentations:

• Workflow overview and update: SCUF 2023 Presentation.

Open Comment Period for IHE EBIW Technical Document (Closes March 2025). Click here to provide comments. 

SCUF Tech Summit and Workflow Workshop 2023

2023 SCUF Workflow Presentation: This presentation covers the basics of workflow and the development of standards, including the ACEP EBIW IHE Workflow update.

Clinical Use Case: Clinical Use Case

Educational Use Case: Educational Use Case

Split and Merge Exception Case: Split and Merge Use Case 

Procedural Use Case: Procedural Use Case

SCUF Tech Summit and Workflow update 2024

We have made a lot of progress in defining POCUS workflows! Check out the 2024 SCUF presentation on workflow. The ACEP IHE Workflow Workgroup has submitted a proposal to IHE for the creation of a new IHE POCUS EBIW Profile. At the time of SCUF 2024 Conference, the most current updated version of the proposed POCUS EBIW Profile can be found here. 

Reports and the creation of dashboards for tracking completion of workflow is a much needed part of any POCUS workflow. Dr. Matt Flannigan presents work done by members from the ACEP EUS IRT. Check out his presentation delivered at the SCUF Tech Summit. 

You can see recent presentations from ACEP's Emergency Ultrasound Section's Industry Round Table from 2021-2024 by clicking on the "Resources" tab above or clicking here. These presentations from thought leaders in emergency ultrasound address the relevant and critical challenges the POCUS community faces today.

Dr. Rob Ferre created and maintains pocusworkflow.com in an effort to collaborate with POCUS leaders and our industry partners. The purpose of the website is to provide a simplified overview of POCUS workflows, with particular attention to encounter based imaging workflows.  The work of physician thought leaders in POCUS is reported on the website.  

For more information, please reach out to Dr. Rob Ferre, rferre@iu.edu 

For more information about Dr. Rob Ferre, please check out his Linkedin profile or his IU School of Medicine bio