POCUS Workflow

Learn more about POCUS workflow

The Basics: Learn terms, definitions and more

The Types: Learn more about the two different types of workflow

The Data: See the results of the 2021 survey of emergency ultrasound leaders

The Pledge: See the ACEP EUS Section's ask for leaders in the POCUS Industry

The Basics

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

The Types

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

The Data

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:

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.

The ACEP/IRT Pledge

A POCUS workflow must to be efficient, reliable and clinician-centered in order to have sufficient buy-in to actually be used in clinical practice. While there are important elements in a workflow that need to account for new learners that do not yet have POCUS privileges, a successful POCUS workflow should be designed from the perspective of the clinician actually performing the exam. From the clinician using POCUS in the clinical space, there are 5 key touchpoints where physicians potentially interact with a component of the workflow. These inculde the following:

Based on prior work, including a 2021 Survey to ACEP Emergency Ultrasound Section members, a strong majority of the Emergency Ultrasound Community prefer an encounter-based workflow. In considering how to make this workflow more efficient, reliable and clinician-centered, the IRT leadership is asking vendors to commit to the following:

All Vendors:

Will you participate in a POCUS Workflow Standards Workgroup by sending a senior engineer to help establish best practice standards and work to create appropriate DICOM tags and an IHE recoginzed encounter based POCUS workflow profile? Send name and title of representative to Rob Ferre, rferre@iu.edu or Rachel Liu rachel.liu@yale.edu by Nov 1, 2022.

Cart Vendors:

Hand Held Vendors:

How will we follow up on these requests? 

Physicians leaders from the IRT meet every other month. We will track these and publish which vendors have met these requests on this webpage. Please send questions or notification of completion of these requests to Rob Ferre, rferre@iu.edu.  

Creating Workflow Standards- The POCUS Workflow Work Group

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:

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

Workflow Presentations:

Workflow Workshop- SCUF 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

ACEP Emergency Ultrasound Section's Industry Round Table Presentations

Check out recent presentations at the Industry Round Table and learn what leaders in emergency ultrasound think are the most relevant problems that need to be addressed by our industry partners.

Need Resources?? Check out our Resources Page. You will find many a variety of aids including:

Want to learn more about how a POCUS workflow fits into system-wide best practices for POCUS? Visit the POCUS Alliance webpage to learn more.