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Radiology and order comms custom statuses. Paul Davison Consultant Radiologist RCR Imaging Informatics Group 25 th 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

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radiology and order comms custom statuses

Radiology and order comms custom statuses

Paul Davison

Consultant Radiologist

RCR Imaging Informatics Group

25th March 2011

the tools
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
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 interactions4
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
HL7 - Order Control Messages
  • Possible order status messages CRIS  ICE:
hl7 message examples
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^KIRKPATRICK 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^KIRKPATRICK JNP|RNZ02BURN||||130|alanstibook|CRIS||^^RNZ02

OBR|||10001293^CRIS|CCALR^CT Calcaneum Rt||||||||||||||||10001231|RNZ10001293|||C|||^^^200510141119^^1|||||||CRIS&Cris user^^^^XMR^^RNZ02

slide7

CRIS

Radiology processes

(paper heavy)

ICE requests

Requesting

Electronic ‘order’ created in ICE by Trust staff

REQ – requested status

‘OK’ Message

Instant

Electronic ‘order’ on CRIS

RCV – received status

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

Batch printing of results and distribution of reports

Verified report

F – Final report status

electronic cris workflow
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 workflow9
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
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
slide11

CRIS

Radiology processes

(now paper light)

ICE requests

Requesting

Electronic ‘order’ created in ICE by Trust staff

Electronic ‘order’ on CRIS

REQ – requested status

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

Accepted requests filtered by A&C staff

Waiting

Pending

APT – appointment status

Appointment made

ATT – attended status

Patient attends

Request printout used for ID

EXM – examined status

Patient examined

RR – Results received status

VR reporting

Reporting

Verified report

F – Final report status

Electronic sign off

cancellation still a problem
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