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Radiology and order comms custom statuses Paul Davison Consultant Radiologist RCR Imaging Informatics Group 25 th March 2011.

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Presentation on theme: "Radiology and order comms custom statuses Paul Davison Consultant Radiologist RCR Imaging Informatics Group 25 th March 2011."— Presentation transcript:

1 Radiology and order comms custom statuses Paul Davison Consultant Radiologist RCR Imaging Informatics Group 25 th March 2011

2 The Tools Radiology RIS systemRadiology RIS system –HSS CRIS version t –Southern cluster shared instance – SHA1 –Order comms interface from original LSP deployment offering Order Communications systemOrder Communications system –Sunquest ICE Release July 09.1/Version 391 (about to upgrade to Alpine)

3 ICE  CRIS interactions Main issues in post OC deploymentMain 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 ICECould not display cancellation reason in ICE Problems with cancelling within multiple ordersProblems with cancelling within multiple orders

4 ICE  CRIS interactions Order status depends on HL7 messages sent between ICE and CRIS – order control segment (ORC)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 ICECRIS OC interface document described ORC messages that should be sent to ICE Can customise the status displayed in ICE through ‘Requesting Configuration’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 ICEMap the order status in segment 5 (ORC:5) to a custom status displayed in ICE In reality we found messages were limitedIn reality we found messages were limited

5 HL7 - Order Control Messages Message Type OrderControlORC:1OrderStatusORC:5Meaning OMG^O19NWSC New order booked on CRIS, appointment booked IP New order booked on CRIS, patient in dept SCSC Status change, appointment booked IP Status change, patient in dept CM Status change, examination performed CACA Order cancelled XOSC Order changed, appointment booked IP Order changed, patient in dept Possible order status messages CRIS  ICE:Possible order status messages CRIS  ICE:

6 HL7 Message examples MSH|^~\&|CRIS|LIVE|GE|| ||OMG^O19| |P|2.4 PID||| ^^^RNZ02^MR~ ^^^NHS^NH~ ^^^CRIS^PI||RICE^DAVID^^^MR|| |M|||39 CLOUGHS ROAD^RINGWOOD^HAMPSHIRE^^BH24 1UU|| / ~||||||||||||||||""|N PD1|||^^J82039|G PV1||||||||||||||||||A ORC|NW || ^CRIS|| SC ||^^^ ^^1|| |CRIS||C ^KIRKPATR ICK JNP|RNZ02BURN||||130|alanstibook|CRIS||^^RNZ02 OBR||| ^CRIS|CCALL^CT Calcaneum Lt|||||||||||||||| |RNZ |||C|||^^^ ^^1|||||||^^^^^^RNZ02 MSH|^~\&|CRIS|LIVE|GE|| ||OMG^O19| |P|2.4 PID||| ^^^RNZ02^MR~ ^^^NHS^NH~ ^^^CRIS^PI||RICE^DAVID^^^MR|| |M|||39 CLOUGHS ROAD^RINGWOOD^HAMPSHIRE^^BH24 1UU|| / ~||||||||||||||||""|N PD1|||^^J82039|G ^MPV1||||||||||||||||||A ORC|SC || ^CRIS|| CM ||^^^ ^^1|| |CRIS||C ^KIRKPATR ICK JNP|RNZ02BURN||||130|alanstibook|CRIS||^^RNZ02 OBR||| ^CRIS|CCALR^CT Calcaneum Rt|||||||||||||||| |RNZ |||C|||^^^ ^^1|||||||CRIS&Cris user^^^^XMR^^RNZ02

7 CRIS ICE requests Radiology processes (paper heavy) Electronic ‘order’ created in ICE by Trust staff Electronic ‘order’ on CRIS REQ – requested status RCV – received status Appointment made Patient attends Patient examined ATT – attended status EXM – examined status Verified report F – Final report status RR – Results received status Requesting Reporting Printout used for ID purposes Batch printing of results and distribution of reports Report dictated and typed Requests vetted APT – appointment status ‘OK’ Message Instant

8 Electronic CRIS Workflow Wanted to move to electronic vettingWanted 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 reportingCombined with VR for vetting and reporting

9 Electronic CRIS Workflow We wanted this CRIS workflow to be represented in ICE for usersWe wanted this CRIS workflow to be represented in ICE for users To achieve this requiredTo 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

10 CRIS Custom status mapping HSS can customise ORC:5 segment in CRIS HL7HSS 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 ICEMapped to new order status in ICE

11 CRIS ICE requests Radiology processes (now paper light) Electronic ‘order’ created in ICE by Trust staff Electronic ‘order’ on CRIS ‘order’ on CRIS received by A&C staff REQ – requested status RCV – received status Received request on CRIS Accepted request on CRIS Request on CRIS vetted by radiologist or designated person (VR) Appointment made APT – appointment status Patient attends Patient examined ATT – attended status EXM – examined status Verified report F – Final report status RR – Results received status Requesting Reporting Accepted requests filtered by A&C staff Request printout used for ID ARR– request arrived VR reporting Electronic sign off ACC – accepted status OK Message Instant WaitingPending

12 Cancellation still a problem ICE looks segment ORC:1 for cancellations and not ORC:5ICE looks segment ORC:1 for cancellations and not ORC:5 Open service request to change this – can then apply customised cancellation statusesOpen service request to change this – can then apply customised cancellation statuses Still issues with multiple ordersStill issues with multiple orders Cancel part of an order in CRISCancel part of an order in CRIS Labelled as ‘no longer required’ by ICELabelled as ‘no longer required’ by ICE Drops out of request in ICEDrops out of request in ICE Only shows as cancelled when all parts cancelledOnly shows as cancelled when all parts cancelled


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