Transcript TRN-0035-12 iSite 3.5: Technologist Workflow

iSite 3.5: Technologist Workflow
Table of Contents
•
Objectives
•
Terminology
•
Technologist Worklist
•
Quality Assurance
•
Resolve Exceptions
•
Delete Image(s)
•
Save Presentation States
•
Link Exams
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
2
Learning Objectives
• Understand “best practices” for image management in relation to
performing provider (radiologic technologist) workflow
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
3
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
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
4
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 imaging
service requests
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
5
Terminology
• DICOM (Digital Imaging COmmunication 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 key
sets of administrative and clinical data in the healthcare enterprise
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
6
Technologist Workflow
1. Quality Assurance
1. Verify Patient Demographics and Exam Information
2. Resolve Exceptions
3. Delete Image(s)
2. Save Presentation States
3. Link Exams
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
7
Technologist Worklist
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
8
Technologist Worklist
• In iSuite or iSite Enterprise from the Folder List
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
9
Technologist Worklist
1. In iSuite, select the Worklist Tab
Step 1
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
10
Technologist Worklist
2. Select Technologist Tab
Step 2
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
11
Technologist Worklist
3. In the Performing Resource registration screen, Select Yes and
next
Step 3
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
12
Technologist Worklist
4. If the institution has multiple organizations the user will need to
select the organization filter
Step 4
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
13
Technologist Worklist
5. Select the search button and choose resource
Step 5
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
14
Technologist Worklist
• Multiple Resources can be selected
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
15
Technologist Worklist
• To Remove a Resource, check the box next to the resource name and
click on the ’–’ button
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
16
Technologist Worklist
7. To change Resources from the Worklist, select the search (…)
button at the Performance Resource indicator
Step 7
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
17
Technologist Worklist
8. Select primary filters
Step 8
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
18
Technologist Worklist
9. Select the status of the exams desired to display
•
The Exam Status defaults to Scheduled and In Progress
Step 9
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
19
Technologist Worklist
10. Selecting the search button (…) next to the date will provide the user with a
calendar
•
The date range defaults to the current date
Step 10
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
20
Technologist Workflow
• Access the Technologist Worklist to find your exam
• An image icon should be seen for all exams with a status of I, C, D, P, or F
• If no image icon exists, ensure the images were sent by the modality or that the
images are exceptions
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
21
Technologist Worklist
Represents a Stat order
Represents an Accession number with an associated image
Represents an Exam Memo
Click on yellow dot next to table heading to sort the list
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
22
Technologist Worklist
• View the list of all orders for this patient
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
23
Technologist Worklist
• Select an accession number to view images, exam audit trail or exam memos
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
24
Technologist Worklist
• Select an accession number to view images, exam audit trail or exam memos
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
25
Technologist Worklist
• Select the ‘view’ button to view images
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
26
Technologist Worklist
• Select the ‘audit’ button to view the exam audit trail
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
27
Technologist Worklist
• Select the ‘Memos’ tab to view exam memos
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
28
Technologist Worklist
• Users who have the VCTCREATE Security Code may add new Exam Memos
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
29
Quality Assurance
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
30
Quality Assurance
• Verify key patient demographics and availability of all images
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
31
Resolve Exceptions
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
32
Exception Resolution
1. Identify Exception
1. Worklist Module
2. Exceptions Handler Option
2. View Exception Images
1. Click on ID hyperlink
2. Click View
3. iSite will present matches based on MRN and Accession Number or
the user may enter a known ACC (from RIS) and apply
1. Additional searches may be performed by clicking find pt/exam button
2. Click on the radio button next to patient’s record
4. Locate the Exam
1. Click on the MRN hyperlink
2. Verify Exam information and apply
5. Verify Resolution of Exception
1. Check patient folder
2. Check inactive/active lists
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
33
“Gold Standard” Patient Record
• In a RIS integrated environment, the iSite database is populated with
patient records and exams by HL7 messages
• The record from the RIS is the record that iSite will consider the Gold
Standard
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
34
Definition of an Exception
• An exception is a study that contains patient or exam information from
the modality which does not match patient demographic information
residing within the iSite database for this patient or exam
• DICOM Metadata, including MRN and/or Accession number, do not
match the iSite database Gold Standard
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
35
Image Validation
• All studies from modalities need to be validated prior to registration into
the iSite database
• Exceptions are studies that fail the automatic validation process and are
identified with (!) an exclamation point in the Patient Directory
• Exception studies require a MANUAL process to validate them into the
database
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
36
Image Validation
• iSite uses an interface (ConnectR) to automatically validate studies into
the database
• ConnectR looks at DICOM Metadata for images and validates the
images with the corresponding exam ordered by the RIS
HL7 Order
ACC
Study (DICOM Metadata)
…
SUID
iSite Database
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
37
Image Header Information
• The Image DICOM Metadata information that ConnectR uses for
validation in a RIS integrated environment is:
• Medical Record Number
• Accession Number
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
38
Image Header Information
Modality
(scanner)
NAME
MRN
ACC #
NAME
MRN
ACC #
Diagnostic
viewing
workstation
iSite Server
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
39
Exception Occurrence in RIS Environment
• DMWL (Dicom Modality Work List) was not used for some reason
– HIS/RIS was down
•
•
•
•
Network or Connectivity Issue
Power Outage
System Reset
Periodic System Maintenance
– Lack of full DICOM support at the modalities
• Technologists must manually enter patient information
• ACC not entered or entered incorrectly
• Modality allows manual entry of MRN or ACC number, but it does not
insert it in the DICOM Metadata
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
40
Exception Occurrence in RIS Environment
• DMWL (Dicom Modality Work List) was not used for some reason
– ER
• Did not have time to order exam in RIS
• No ACC number assigned when exam started
– Workflow Error
• ACC or Exam was cancelled while exam was in progress
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
41
Identifying Exceptions
• In iSite Enterprise
– Patient Directory (identify exceptions with an ‘!’ next to the
patient’s name)
– Worklist Filters
– Exceptions Handler Folder
• In iSuite
– Exceptions Handler tab within the Worklist tab
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
42
Exceptions Handler
• In iSuite or iSite Enterprise from the Folder List
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
43
Exceptions List
• Select an Exceptions List
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
44
Exceptions List
• A New Exceptions Worklist may be built
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
45
Exceptions List
• Active or Inactive Status
• Reason (e.g. ACC not found)
• Patient Sex
• Performing Resources
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
46
Exceptions List “Best Practices”
• 2 Days is recommended for
Date Range
• ACQ and FIND are
recommended for Type
• Modality is recommended in
most instances
• To select a modality click the
(…) button
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
47
Exceptions List
• Select the modality from the
pop-up Equipment Directory
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
48
Identifying Exceptions
• An Additional Search may be made using Patient Name or Accession
Number as well as other identifiers
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
49
Resolve Exceptions
• An Exception may be resolved by selecting the ID hyperlink
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
50
Resolve Exceptions
• View the image by selecting the ‘View’ button
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
51
Resolve Exceptions
• Images of poor quality may be removed by selecting the
‘remove’ button
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
52
Resolve Exceptions
• iSuite conducts a Database search for a matching MRN (Patient ID)
and ACC (Accession Number)
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
53
Resolve Exceptions
• Locate the Patient’s Record/Exam
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
54
Resolve Exceptions
• Select the correct Accession Number to which the images belong
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
55
Resolve Exceptions
• If ACC number is known it may be entered in the field
• ACC number entered must represent a valid exam that the RIS ordered or it
will be rejected
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
56
Resolve Exceptions
• ‘find pt/exam’ may be used to perform additional searches
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
57
Resolve Exceptions
• iSuite conducts a Database search for a Name, although additional
searches may be made
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
58
Resolve Exceptions
• Select the ‘apply’ button
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
59
Resolve Exceptions
• Resolve the Exception by confirming the selection
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
60
Exception Resolution Verification
• Verify the Exception is now in the ‘Inactive’ Exception List and no longer
in the ‘Active’ Exception List
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
61
Exception Resolution Verification
In iSite Enterprise verify:
• Exception with the “!” is no longer there
• Exception’s Images or study are now part of the patient’s original folder
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
62
Delete Image(s)
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
63
Delete Image(s)
• Images may be deleted by “right clicking” on an image and selecting
‘Delete’ from the Context Menu
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
64
Delete Image(s)
• A Reason must be selected from the list presented
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
65
Delete Image(s)
• The “Delete Image” feature is available only if the user has the
Security Code: ISTIMGDEL
• The “Delete Image” feature is accessed by right clicking on an image
thumbnail on the Exam Rack
• The “Delete Image” feature does not allow all images in an exam to be
deleted
• The “Delete Image” feature will not allow images to be accepted, in
most cases, if resent from the modality
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
66
Recover Deleted Images
• Deleted Images may be recovered by “right clicking” the Exam Rack Shelf
Bar and selecting “Recover Deleted Images”
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
67
Recover Deleted Images
• The “Recover Deleted Images” option is available only if the user has
the Security Code: ISTIMGDEL
• Images may be recovered by “right clicking” the Exam Rack Shelf Bar
• All deleted images for the exam are recovered
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
68
Delete Image(s)
• The “Delete Image” feature may be used to delete images which were
sent in error, if the images will not be resent to Philips iSite PACS
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
69
Save Presentation States
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
70
Technologist Workflow
• Any of the following modifications may be saved as part of a
Presentation State:
–
–
–
–
–
–
–
–
–
–
–
Window Width and Window Level
Measurements, excluding Point Value
Annotations
Invert Image
VOI LUT
Clone
Key Images
Flip
Rotate
Sort
Split
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
71
Technologist Workflow
• A Presentation State may be created
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
72
Technologist Workflow
• A “Technologist” Presentation State may be saved by the performing
provider (radiologic technologist) to modify image presentation prior to
the radiologist viewing and interpreting the exam
• Otherwise, the “Original DICOM” presentation is automatically applied if
no Presentation States have been defined for this exam
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
73
Presentation States Hierarchy
1. “Mark Read” Presentation State is the highest priority Presentation
State. If a “Mark Read” Presentation State has been defined this will
automatically be applied.
2. “Pre-Read” Presentation State is the second highest priority
Presentation State. The “Pre-Read” Presentation State enables a
radiologist to save image presentation modifications without requiring
the exam be “Mark Read,” so the radiologist may later return to the
exam.
3. “Technologist” Presentation State enables the radiologic technologist to
modify image presentation prior to the radiologist viewing and
interpreting the exam.
4. “Original DICOM” Image Presentation is automatically applied if no
Presentation States have been defined for the exam.
5. “User” Presentation State enables specialists to modify image
presentation prior to and following radiologist interpretation without
effecting other users.
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
74
Technologist Workflow
• A Presentation State icon is displayed on the Exam Rack Shelf Bar
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
75
Link Exams
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
76
Exam Linking
• Linking Exams provides the ability to associate multiple exams (orders)
with a single study (image acquisition)
• Linking Exams is necessary in an environment where multiple orders
and multiple dictation events are created for a single image acquisition
sequence
• Linking Exams permits the association of a single image acquisition (ex.
CT Chest, Abdomen, Pelvis) with multiple exams as demonstrated on
the Patient Directory and Patient History Timeline
* Exam Linking is preferably performed prior to image acquisition by the performing
Radiologic technologist; however, exam linking may be performed after acquiring
images.
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
77
Exam Linking
• Linking Exams does not link reports
• It is not possible to “link” exam notes to linked exams
• For example: When CT CHEST, ABDOMEN, PELVIS exams are linked
and a user creates an Exam Memo attached to the CHEST exam, the
Memo will not show up in the Worklist and canvas page associated with
the ABDOMEN and PELVIS exams
• Caution: A note might contain information in regards to the linked exams
that will be missed by the reading physician or clinician
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
78
Exam Linking
• Exams may be linked by selecting the box next to the patient’s name
when there are multiple exam orders associated with a single image
acquisition event
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
79
Exam Linking
• The system will not allow linking of multiple patients
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
80
Exam Linking
• If the exam status is ‘In Progress’ or ‘Scheduled’ select ‘link & begin’
• Note: If ‘link & complete’ is selected this may cause the exams to
prematurely populate Worklist filters
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
81
Exam Linking
• ‘link & complete’ may safely be used after image acquisition and when
the exam status is already set to ‘Completed’ by the RIS
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
82
Unlinking Exams
• To Unlink: Select the exam(s) you wish to unlink
• The Linked Exams dialog will appear automatically
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
83
Unlinking Exams
• To Unlink: Select the exam(s) you wish to unlink and press unlink
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
84
Unlinking Exams
Warning:
• Technologists can unlink an image study from an exam in D
(Dictated), P (Preliminary), F (Finalized), A (Addended) or R
(Revised) status
• If a technologist unlinks an image study from an exam with one of
these statuses, the radiologist's diagnostic report may be effected
because the report was dictated when the images were originally
linked to the exam
• For example, a report may make reference to or include a
diagnosis based upon the image to which it was once linked
• If this were the case and the image study is no longer linked to the
exam/report, the image reference is lost if not re-linked to the
appropriate exam
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
85
Technologist Workflow
1. Quality Assurance
1. Verify Patient Demographics and Exam Information
2. Resolve Exceptions
3. Delete Image(s)
2. Save Presentation States
3. Link Exams
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
86
For assistance, please call customer support at
1-877-328-2808 or 1-877-328-2809
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
87
CONFIDENTIAL
TRN-0035-12 Rev 07/20/06
88