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Monief Eid
BSc, Lean Six Sigma Black Belt, PROSCI, C A P, ITIL V3 Foundation and Prince2 Certified
National PACS Program Director
The National BIG Picture: Tele-medical Imaging, The Vision
for Patient Services (modified based on non-disclosing
information about MOH)

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National Tele-Radiology Project
- Partnered with Canada
Infoway to build up the
RFP. Also participated in
the evaluation
- Choose IHE Approach
- Build up use cases and
business scenarios
- Build up Project standard
- Project is targeting all
MOH hospitals into
stages

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MOH Tele-Radiology Project
Developing Imaging Use Cases
Like most eHealth programs around the world, the challenge to identify and document
the very large number of business use cases and variants is avoided by using a “middle-
out” methodology. The core requirements start with the Interoperability Use Cases,
especially when those are “classical use cases” that have been analyzed by the profiles
and standards development organizations in their prior work.
Middle-Out Methodology Steps for the eHealth Standard based Interoperability
Specification and Policy Project illustrates the main steps of such a methodology,
where the knowledge of the array of Business Scenarios come from the stakeholders
and a validation performed through their experiences (i.e. issues and gaps corrected
based on their feedback).
The Interoperability Use Cases provide a description of the workflows that need to be
addressed and the main exception situations. They are not expected to cover all design
details in term of error codes, data element specification and terminology code sets to
be used.

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MOH Tele-Radiology Project
Developing Imaging Use Cases …….
Definitions
Business Scenario:
A Business Scenario is a sequence of activities by one or more users (e.g. patients,
clinicians, etc.) that reflects a real-world “story”. From this “story”, various use cases are
derived. Some of these use cases relate to interactions between systems and facilities
sharing health information, and are called Interoperability Use Cases.
Interoperability Use Case:
In software engineering, a Use Case is a technique for capturing the potential
requirements of a new system or a software change. Each Use Case provides one or
more process flow scenarios that convey how the system should interact with the end
user or another system to achieve a specific business goal.
In the context of the specification of interoperability requirements, a use case provides
one or more scenarios in the form of information flows that convey how systems should
interact with other systems as driven by the end user to achieve a specific business or
clinical goal.

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MOH Tele-Radiology Project
Imaging Use Cases
Institutes (Hospital, PHC, Clinic) with Local RIS/PACS – and Tele-Rad Service Not Used (But
connected to DIRS/TRS)
a) Acquire imaging study on local PACS
b) Local PACS accesses local and Saudi
Imaging Repository prior images and
reports
 1 - Q/R Images and Reports
c) Radiologist reads images and creates
report on local RIS/PACS
d) Store newly acquired images and reports
into Saudi Imaging Repository
 2 – Store Images and Reports

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MOH Tele-Radiology Project
Imaging Use Cases
Institutes (Hospital, PHC, Clinic) with No Local RIS/PACS – and connected to National DIRS/TRS Service
(But no Tele-Rad)
- Shared TRS/DIRS Service Platform - used as if local RIS/PACS
- Gateway acts as a RIS/PACS - communicates with local HIS & Modality
(acquires images)
- Gateways use the same common standards (e.g. HL7 and DICOM) - very
well understood and implemented in many KSA hospitals, therefore not
specified
a) Acquire imaging study from local modalities
b) Q/R prior images and reports from Saudi Imaging Repository
1 – Q/R Images and Reports
c) Radiologist reads images and creates report on National TRS (using
PACS Wks.)
d) Store newly acquired images and report into Saudi Imaging Repository
2 – Store Images and Reports

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MOH Tele-Radiology Project
Imaging Use Cases
Institutes (Hospital, PHC, Clinic) with No Local RIS/PACS – National DIRS/TRS and having Tele-Rad
Services
a) Acquire imaging study from local modalities
b) Store Images on Saudi Imaging Repository
1 – Store Images
c) Issue Order to Tele-Rad Service
d) Tele-Rad Mgr. manages workstation (reading worklist, relevant prior
images and reports, etc.)
 2 – Q/R Images and Reports
e) Tele-Rad Wks. creates report, Tele-Rad Mgr. stores report on Saudi
Imaging Repository
 3 – Store Report
f) Tele-Rad Manager updates order status to “complete”
g) National TRS/DIRS Q/R report and displays on National PACS
Workstation
4 – Q/R Report

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MOH Tele-Radiology Project
Imaging Use Cases
Institutes (Hospital, PHC, Clinic) with Local RIS/PACS Uses Tele-Rad as Back Up Service
Tele-Rad Service used when local radiologist is not available
a) Acquire imaging study on local PACS and store images to
Saudi Imaging Repository.
 1 – Store Images
b) Issue Order to Tele-Rad Service
2 – Issue Tele-Rad Order
c) Tele-Rad Mgr. manages Tele-Rad workstation (reading
worklist, relevant prior images and reports, etc.)
3 – Q/R Images and Reports
d) Tele-Rad Wks. creates report, Tele-Rad Mgr. stores on
Saudi Imaging Repository.
4 – Store Report
e) Tele-Rad Manager updates order status to “complete”
5 – Status Update
f) RIS/PACS Q/R report to store locally
6 – Q/R Report

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MOH Tele-Radiology Project
Imaging Use Cases
Interoperability Comparison for the Four Configurations
1. Local RIS/PACS
Tele-Rad Service Not Used
2. Local RIS/PACS
Uses Tele-Rad
as Back Up
3. No Local RIS/PACS
National RIS/PACS Service
(no Tele-Rad)
4. No Local RIS/PACS
National RIS/PACS
and Tele-Rad Services
1&3 – Same Interoperability Requirements
2&4 – Same Interoperability Requirements
Standalone RIS/PACS Workflow
 Q/R Images and Reports (prior)
 Store Images and Reports (new)
RIS/PACS Using Tele-Rad Workflow
 Store Images (new)
 Q/R Images and Reports (prior)
 Issue Tele-Rad Order (new)
 Store Report (new)
 Update Order Status (completed)
 Q/R Report

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MOH Tele-Radiology Project
Use Case Actors Example:

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MOH Tele-Radiology Project
Use Case Actors Example:

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MOH Tele-Radiology Project
Data Content:

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MOH Tele-Radiology Project
Use Case Actors:
Imaging Information Source
• Produces and publishes imaging documents
Imaging Information Consumer
• Queries and retrieves images
Imaging Report Consumer
• Queries and retrieves reports
Imaging Repository
• Store and provide access to images and reports
• Maintains metadata

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MOH Tele-Radiology Project
Benefits of National Tele-Radiology Project:
Sharing Images and Reports
• Timely access to studies and reports
• Reduce duplicated Imaging
• Support for Tele-radiology
Tele-radiology Orders
• Access to radiologists during off-hours
• Access to specialists from all over Saudi
• Load balancing during periods of heavy load
• Better care and reduced errors

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MOH Tele-Radiology Project

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MOH Tele-Radiology Project

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MOH Tele-Radiology Project
Publish Document(s)
Query/Retrieve
Document(s)
Notification of
Document Availability
Retrieve Images
Send Images
LegendLegend
Service
Actor
Imaging Information
Source
Imaging Information
Consumer
Imaging Report
Consumer
Imaging
Repository
Service Model

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MOH Tele-Radiology Project
Tele-Radiology
Order Creator
Tele-Radiology
Order Fulfiller
Tele-Radiology
Order Forwarder
Manage Order
Service Model

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MOH Tele-Radiology Project
Data Content:

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MOH Tele-Radiology Project
Data Content:

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Thank You ………. Q & A