Transcript TRN-0035-01 iSite 3.5: Workflow

iSite 3.5: iSite Workflow
Table of Contents
• Objectives
• Terminology
• iSite Workflow
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Objectives
• Understand the importance of Exam Statuses used in Philips iSite
PACS
• Know and understand the exam lifecycle, exam statuses, the
associated trigger events, and the related message types that are
important to Philips iSite PACS workflow
• Know important considerations related to Philips iSite PACS workflow
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Terminology
• PACS (Picture Archive and Communications System)
– Information Systems designed to manage, store and distribute
medical images and related information throughout the healthcare
enterprise
• HIS (Hospital Information System)
– Information Systems designed to manage patient records, including
patient registration, billing, and order entry
• RIS (Radiology Information System)
– Information Systems designed to manage exams (orders), including
filling orders and scheduling
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Terminology
• MRN (Medical Record Number)
– A unique patient identifier (also known as Patient ID) used for
auditing of billing and scheduling for patients
• Accession Number (ACCession Number)
– A unique exam identifier (also known as an order number or
requisition number) used for auditing of billing and scheduling of
scheduled procedures
• SUID (Study Instance Unique IDentifier)
– A unique study identifier used for auditing of performed procedures
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Terminology
• DICOM (Digital Imaging COmmunications in Medicine)
– DICOM is the predominant communication standard between
imaging equipment throughout the Healthcare Enterprise
• HL7 (Health Level 7)
– HL7 is the predominant messaging standard for exchanging
administrative and clinical data in the healthcare enterprise
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iSite Workflow
• Workflow is a procedural (step-by-step) description of how clinical and
business processes are performed
• Key Areas of Clinical Workflow
–
–
–
–
Physician Workflow
Technologist Workflow
Radiologist Workflow
Administrative Workflow
Workflow
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iSite
Modality
iSite Workflow
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
Patient Registration
Patient Admission
Patient Transfer
Patient (Demographic) Update
Patient Discharge
Patient Merge
New Order
Order Status Change
DICOM Modality Worklist Query
DICOM Modality Worklist Response
DICOM Modality Performed
Procedure Step (In Progress)
iSite “In Progress”
DICOM Modality Performed
Procedure Step (Complete)
DICOM Store Commitment (Request)
DICOM Store Commitment
(Response)
Order Complete
Report Dictated
iSite “Mark Read”
Report Preliminary
Report Finalized
Report Addended
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RIS
Dictation
HIS
HIS
RIS
PACS
Modality
Report
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iSite
Modality
iSite Workflow
2. Patient
Admission
RIS
Dictation
HIS
15. Storage
Commitment
Acknowledgement
1. Patient
Registration
HIS
3. Patient
Transfer
14. Storage
Commitment
Request
11. Modality
Procedure Step
In Progress
7. New
Order
4. Patient
Update
12. iSite
“In Progress”
5. Patient
Discharge
13. Modality
Procedure
Step
Completed
8. Order
Status
Change
6. Patient
Merge
RIS
17. Report
Dictated
PACS
Modality
16. Order
Complete
18. iSite
“Mark Read”
10. Modality
Worklist
Response
19. Report
Preliminary
20. Report
Final
21. Report
Addended
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9. Modality
Worklist
Query
Reporting
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iSite
Modality
Patient Registration
RIS
Dictation
HIS
PACS
HIS
1. Patient Registers for hospital services (ADT_A04) messages
•
iSite associates with existing patient or creates if no patient match
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iSite
Modality
Patient Admission
RIS
Dictation
HIS
PACS
HIS
2. Patient is Admitted (ADT_A01) messages
•
iSite associates with existing patient or creates if no patient match
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Patient Transfer (Patient Visit Location)
iSite
Modality
RIS
Dictation
HIS
PACS
HIS
3. Patient Transfer Messages (ADT_A03) messages
• Update Patient Location as displayed on the Patient Page
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iSite
Modality
Patient (Demographic) Update
RIS
Dictation
HIS
PACS
HIS
4. Patient (demographic) Update (ADT_A08) messages
•
iSite associates with existing patient or creates if no patient match
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iSite
Modality
Patient Discharge
RIS
Dictation
HIS
PACS
HIS
5. Patient Discharge (ADT_A02) messages are NOT relevant to Philips
iSite PACS workflow, unless a corresponding Patient Record does not
exist in Philips iSite PACS in which case the Patient Record will be
created in the iSite Database
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iSite
Modality
Patient Merge
RIS
Dictation
HIS
PACS
HIS
6. Patient Merge (ADT_A18, ADT_A34, ADT_A40) messages will
populate the iSuite Merge List for manual confirmation prior to merge
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iSite
Modality
New Order
RIS
Dictation
HIS
PACS
RIS
7. RIS sends “New Order” upon Order Scheduling (ORMNW)
or
RIS sends “New Order” upon Patient Check-in (ORMNW)
•
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iSite DICOM Modality Worklist available for exam
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iSite
Modality
New Order
RIS
Dictation
HIS
PACS
RIS
•
Matching Exams and Studies:
–
iSite matches patient and exam information from the modality to
information from the RIS
–
The MRN and Accession Number values from the exam and study
must exactly match to associate an acquired study with an exam
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iSite
Modality
Order Status Change
RIS
Dictation
HIS
PACS
RIS
8. Order Status Change (ORM/SC) should be performed prior to
DICOM Modality Worklist Query
•
RIS may send cancel message (ORM/CA or ORM/OC) if order
is updated – this will cause an exception in iSite
•
Accession Numbers for canceled orders may not be reused
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iSite
Modality
DICOM Modality Worklist
RIS
Dictation
HIS
PACS
Modality
9. Technologist queries DICOM Modality Worklist
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iSite
Modality
DICOM Modality Worklist
RIS
Dictation
HIS
PACS
Modality
10. iSite responds to DICOM Modality Worklist as appropriate
•
Patients may “appear” in queue upon “Patient Check-in” or may be
prescheduled; either method uses the Scheduled DTTM -24 and +2 if
the exam is currently (at time of query) in “scheduled” or “in-progress”
status
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Modality Performed Procedure Step
iSite
Modality
RIS
Dictation
HIS
PACS
Modality
11. Modality Notifies iSite that Procedure Step is “In Progress”
NOTE: iSite will not display images marked as “Discontinued” procedures
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iSite
Modality
“In Progress”
RIS
Dictation
HIS
PACS
Modality
12. The iSite “In Progress” exam status is triggered internally upon receipt
of images from the modality
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Modality Performed Procedure Step
iSite
Modality
RIS
Dictation
HIS
PACS
Modality
13. Modality Notifies iSite that Procedure Step is “Completed”
NOTE: iSite will not display images marked as “Discontinued” procedures
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iSite
Modality
Storage Commitment
RIS
Dictation
HIS
PACS
Modality
14. Modality requests image storage commitment
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iSite
Modality
Storage Commitment
RIS
Dictation
HIS
PACS
Modality
15. iSite responds to modality request for image storage commitment
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iSite
Modality
Order Complete
RIS
Dictation
HIS
RIS
PACS
16. Upon completion of Image Acquisition, Post-Processing, and Quality
Assurance the radiologic technologist completes the exam in the RIS
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iSite
Modality
Technologist Workflow
RIS
Dictation
HIS
RIS
PACS
•
Image Quality Assurance – Radiologist Reading Worklists are typically
filtered by Complete status and Unread Only status
•
Exams not specifically Marked Read will appear on the appropriate
filter if the exam status is also Complete
•
Philips highly recommends that performing providers (typically
radiological technologists) manage quality assurance prior to exam
Complete status to ensure timely exam interpretation
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iSite
Modality
Technologist Workflow
RIS
Dictation
HIS
Document
Scanner
PACS
•
Radiological Technologists may write clinical notes on the requisition
form
•
Documentation of notes may be electronically captured within the RIS
•
Digitized paper requisitions (including handwritten notes) can be
stored as part of the imaging study
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Reading Worklist
• Worklist Filters – Exam Code, Body Part, Subspecialty and Performing
Resource Dictionary information as well as other information from the
order message used as filtering criteria
• Hanging Protocols – Hanging Protocols may be specified for all exams
of one Modality Type or for exams of one Modality Type and Body Part
or based upon Exam Code
• Relevant Exams – Relevant Exams are determined by the loaded
Hanging Protocol; the relevant prior may be based upon Body Part only
or Modality Type and Body Part
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Acquiring Prior and Outside Films
• Patient History Timeline – provides comprehensive patient record
• Relevant Priors – timeline broken into relevant and non-relevant prior
exams (driven by the loaded Hanging Protocol)
• Prior Results – all results associated with finalized exams are available
• 3rd Party Digital Archives
– Historical Migration Services
– On-Demand Query/Retrieve (iQuery)
• Film Archives and Outside Films
– Digitizers
– Light Boxes
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iSite
Modality
Report Dictation
RIS
Dictation
HIS
Report
System
PACS
17. Upon the completion of dictation, the dictation system may send a
message indicating Dictated status
•
No report available, merely a status update
•
Dictated status is typical of businesses that use professional
transcription services
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“Mark Read”
iSite
Modality
RIS
Dictation
HIS
Report
System
PACS
18. The “Mark Read” feature in iSite flags exams, which have been
reported, to immediately “fall-off” radiology reading Worklist Filters so
exams are not “double read”
•
The “Mark Read” feature automatically saves a Presentation State when
selected
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iSite
Modality
Report Preliminary
RIS
Dictation
HIS
Report
System
PACS
19. Upon the issuance of initial report, the dictation system may send a
message indicating preliminary status
•
A Report is available
•
Report text may be overwritten
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iSite
Modality
Report Finalized
RIS
Dictation
HIS
Report
System
PACS
20. Upon the issuance of final report, the dictation system may send a
message indicating final status
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iSite
Modality
Report Addended
RIS
Dictation
HIS
Report
System
PACS
21. Report addendum allows the user to insert additional report text rather
than overwriting the current report text
•
iSite Database is currently limited to a single report addendum
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Delivering Images
• Remote Access – use of VPN clients to connect outside users into the
system using iSite Enterprise
• CD Burning – use of CDs with embedded iSite Enterprise viewer
• Print to Paper – referring physicians may print non-diagnostic images
on a standard printer to create added value for patients
• Printing to Film – traditional method for delivering images to outside
organizations and providers
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For assistance, please call customer support at
1-877-328-2808 or 1-877-328-2809
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