The document discusses extending the Patient Synchronized Applications (PSA) profile to enable additional clinical workflows. It proposes adding messaging services and distributed diagnosis capabilities that allow clinicians to: 1) Send notifications to other clinicians about a patient's care. 2) Invite expert clinicians to join a read-only diagnosis session on a patient's record for discussion via a chat protocol. Messages flagged for medical reference are stored in the patient's record. 3) View a shared patient record and contribute to treatment via chat during distributed diagnosis sessions.

1. EXTENDING THE PATIENT SYNCHRONIZED APPLICATIONS PROFILE WITH TOOLSFOR DISTRIBUTED DIAGNOSIS Harald Köstinger, Thomas Grechenig, Klaus Bayrhammer, Michael Fiedler, Wolfgang Schramm Vienna University of Technology Research Group for Industrial Software (INSO)

2. Motivation modern Hospital Information Systems (HIS) consist of various clinical and administrative software packages to enable as seamless as possible workflows. many workflows require the utilization of different software applications by the same professional. the professional has to select the same patient in each clinical or administrative application.

3. Goals  create a software component in background could reduce the risk of erroneous documentation by accidentally selecting the wrong patient and the time needed for the manual selection process The IHE PSA Profile already provides the necessary mechanisms for this!  create a software component which enables additional workflows on the basis of the PSA profile.

4. Patient Synchronized Application (PSA) is an existing IHE (Integrating the Healthcare Enterprise) Profile enhances the quality and supports the clinical work with EHR data on e.g. workstations, radiology systems, and mobile devices a PSA context manager (CM) keeps track of current selections and reduces the recurring task of selecting patients in different applications applications connected to the CM get notified about the selection status selecting a patient in one application causes all other running applications to select the same patient

5. PSA: Architecture Overview Clients within the same context (related to a signed up expert) get notified about ongoing selection changes

6. PSA: Extension to the Existing Infrastructure the PSA principals create the basics for the introduced Conferencing Features Message Services connected clients appear in a list on the CM clients then can send notifications to others Distributed Diagnosis clients can access the list of online experts experts can be invited to a distributed diagnosis of patient records

7. Message Services clients can send notifications to other clients mainly used to forward current health care information about a certain patient or to add some more information which is not part of the documentary process yet allows to already brief the next doctor in the row of a clinical workflow about the next incoming patient

8. Distributed Diagnosis clients can invite other experts to join a distributed diagnosis session for a certain patient record/document mainly used to discuss unclear findings and results with experts in certain fields or when doctors need to share documents with other physicians to benefit from their knowledge the invitee gets a notification and can join a read-only session on the shared document a chat allows for exchanging of new findings and serves as “distributed diagnosis protocol”

9. Distributed Diagnosis: The Invitation Dr. Alice selects a document and invites a selected professional to a distributed diagnosis session. The invitee (Dr. Bob) gets notified about this action and can decide whether to join or decline the invitation. After joining the session, a Dr. Bob gets a read-only view of the shared document and can contributed to the current treatment process via the chat protocol.

10. The chat protocol allows the selection of messages which should be kept as a medical reference. Those messages are stored as part of the patient record. Other messages are discarded after the session is closed. The two experts have the same view on the record. Only the invitee cannot edit data – the view is read-only.

11. Results and Discussion our system shows how to build a PSA compliant architecture and how this can be extended by messaging services. the proposed work is now part of a research HIS which is currently being developed. further studies to evaluate issues in a realistic clinical IT environment have to be performed