Transcript SC - UK Imaging Informatics Group

Radiology and order comms
custom statuses
Paul Davison
Consultant Radiologist
RCR Imaging Informatics Group
25th March 2011
The Tools
• Radiology RIS system
– HSS CRIS version 1.06.12t
– Southern cluster shared instance – SHA1
– Order comms interface from original LSP deployment
offering
• Order Communications system
– Sunquest ICE Release July 09.1/Version 391 (about to
upgrade to Alpine)
ICE CRIS interactions
• Main issues in post OC deployment
– Limited representation of radiology workflow –
pathology orientated
– ICE did not show appointment information unless
directly appointed from order
– ‘Incorrect’ exams – ICE did not support changed
orders in CRIS e.g. RL or CTMR
– ‘Added’ orders in CRIS not supported
– Cancellation of orders in CRIS –
• Could not display cancellation reason in ICE
• Problems with cancelling within multiple orders
ICE CRIS interactions
• Order status depends on HL7 messages sent
between ICE and CRIS – order control segment
(ORC)
• CRIS OC interface document described ORC
messages that should be sent to ICE
• Can customise the status displayed in ICE
through ‘Requesting Configuration’
• Map the order status in segment 5 (ORC:5) to a
custom status displayed in ICE
• In reality we found messages were limited
HL7 - Order Control Messages
• Possible order status messages CRIS  ICE:
Message
Type
Order
Control
ORC:1
Order
Status
ORC:5
Meaning
OMG^O19
NW
SC
New order booked on CRIS, appointment
booked
IP
New order booked on CRIS, patient in dept
SC
Status change, appointment booked
IP
Status change, patient in dept
CM
Status change, examination performed
CA
CA
Order cancelled
XO
SC
Order changed, appointment booked
IP
Order changed, patient in dept
SC
HL7 Message examples
MSH|^~\&|CRIS|LIVE|GE||20051014112020||OMG^O19|10016261|P|2.4
PID|||0471579^^^RNZ02^MR~420 449
8396^^^NHS^NH~10001041^^^CRIS^PI||RICE^DAVID^^^MR||19430310|M|||39 CLOUGHS
ROAD^RINGWOOD^HAMPSHIRE^^BH24 1UU||01425 473240 / 01425 4712~||||||||||||||||""|N
PD1|||^^J82039|G3367427
PV1||||||||||||||||||A
ORC|NW||10001292^CRIS||SC||^^^200510141119^^1||200510141119|CRIS||C3142130^KIRKPATR
ICK JNP|RNZ02BURN||||130|alanstibook|CRIS||^^RNZ02
OBR|||10001292^CRIS|CCALL^CT Calcaneum
Lt||||||||||||||||10001231|RNZ10001292|||C|||^^^200510141119^^1|||||||^^^^^^RNZ02
MSH|^~\&|CRIS|LIVE|GE||20051014112050||OMG^O19|10016285|P|2.4
PID|||0471579^^^RNZ02^MR~420 449
8396^^^NHS^NH~10001041^^^CRIS^PI||RICE^DAVID^^^MR||19430310|M|||39 CLOUGHS
ROAD^RINGWOOD^HAMPSHIRE^^BH24 1UU||01425 473240 / 01425 4712~||||||||||||||||""|N
PD1|||^^J82039|G3367427^MPV1||||||||||||||||||A
ORC|SC||10001293^CRIS||CM||^^^200510141119^^1||200510141120|CRIS||C3142130^KIRKPATR
ICK JNP|RNZ02BURN||||130|alanstibook|CRIS||^^RNZ02
OBR|||10001293^CRIS|CCALR^CT Calcaneum
Rt||||||||||||||||10001231|RNZ10001293|||C|||^^^200510141119^^1|||||||CRIS&Cris
user^^^^XMR^^RNZ02
Requesting
CRIS
ICE requests
Radiology processes
(paper heavy)
Electronic ‘order’ created in
ICE by Trust staff
REQ – requested status
RCV – received status
‘OK’ Message
Instant
Electronic ‘order’ on
CRIS
Requests vetted
APT – appointment
status
Appointment made
ATT – attended status
Patient attends
Printout used for ID
purposes
EXM – examined status
Patient examined
RR – Results received
status
Report dictated and
typed
Reporting
F – Final report status
Verified report
Batch printing of
results and
distribution of
reports
Electronic CRIS Workflow
• Wanted to move to electronic vetting
– Orders in CRIS received by A&C staff
– Received requests (RR) filtered and then
vetted by appropriate staff
– Become accepted requests (RA)
– Accepted requests filtered by A&C staff
– Create appointments/waiting/pending lists
– Subsequent processes little changed
• Combined with VR for vetting and
reporting
Electronic CRIS Workflow
• We wanted this CRIS workflow to be
represented in ICE for users
• To achieve this required
– Service request to CSC to ‘open interfaces’ to
send XO messages for changed orders
– Software upgrade of ICE able to respond to
changed order messages and added exams
– Enhancement of CRIS HL7 messages to send
more status messages
– Mapping new CRIS status messages in ICE
CRIS Custom status mapping
• HSS can customise ORC:5 segment in
CRIS HL7
– Create a custom translation table in CRIS
Setup (speak to HSS!)
– Provided event can be made to trigger a status
change in the database
– CRIS looks at translation table and sends the
customised HL7 message
• Mapped to new order status in ICE
Requesting
CRIS
ICE requests
Radiology processes
Electronic ‘order’ created in
ICE by Trust staff
REQ – requested
status
(now paper light)
Electronic ‘order’ on
CRIS
OK Message
Instant
‘order’ on CRIS
received by A&C staff
ARR– request arrived
Received request on
CRIS
RCV – received status
Request on CRIS
vetted by radiologist or
designated person
(VR)
ACC – accepted
status
Accepted request on
CRIS
Waiting
Pending
APT – appointment
status
Appointment made
ATT – attended status
Patient attends
Accepted requests
filtered by A&C staff
Request printout used for ID
EXM – examined status
Patient examined
RR – Results received
status
VR reporting
Reporting
F – Final report status
Electronic sign off
Verified report
Cancellation still a problem
• ICE looks segment ORC:1 for cancellations
and not ORC:5
• Open service request to change this – can
then apply customised cancellation statuses
• Still issues with multiple orders
• Cancel part of an order in CRIS
• Labelled as ‘no longer required’ by ICE
• Drops out of request in ICE
• Only shows as cancelled when all parts
cancelled