Radiology and order comms custom statuses

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

2. 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)

3. 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

4. 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

5. HL7 - Order Control Messages • Possible order status messages CRIS  ICE:

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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