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Critical Results Reporting

Learn about the priority NOW and later notifications used for critical patient results reporting, methods of notification, and the patient locator system. Understand the processes, stakeholders involved, and log activities for successful communication.

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Critical Results Reporting

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  1. Critical Results Reporting

  2. Use case: “NOW notification” • This is a Priority interrupt • Drop what you're doing, react now • your patient may die today, e.g., pneumothorax • A chest X-ray reveals a pneumothorax • The reading radiologist immediately • Obtains provider information for patient, from imaging order information. • Obtains notification information for the provider(s) involved. • Sends NOW notifications by all identified methods. Sends NOW notifications by all identified methods. (Page, Office, Nursing station) • Tries to locate patient • Sends NOW notification to patient location • ER Physician responds to page, and accepts responsibility • Treats patient • Closes out patient NOW issue later. • Radiologist • Notes that ER Physician has taken responsibility. Closes out NOW notifications. • ER Nursing station • Responds to message, is informed of ER Physician that has been notified and accepted responsibility.

  3. “NOW” notification Notification Sender PWP Notification Repository Notification Recipient NOW Event Find Notification Methods Find Patient SMS Issue multiple Notification NOW Call Office Page Call Nursing Stn Call Exam Room Multiple Log events (for each attempt) Returns Page Log success on page, log closure on SMS, Office call, nursing call, exam room call Log Success and Completion On page. An hour or two later After treating patient? Same person? Different person? Patient Locator

  4. Use case: “later” notification • This should not interrupt the patient treatment • Schedule a follow-up, your patient might die next year, e.g., suspicious lung mass. • Chest X-ray to check for broken ribs after traffic accident reveals suspicious lung mass. • Radiologist • Writes Report, finishes order • Obtains notification information for “later” notifications for that provider. Patient’s internist is listed. • Sends a “later” notification to the internist, indicating the relevant report to read. • Internist • Receives notification. • Retrieves report, takes responsibility, notifies radiologist of accepting responsibility. • Interacts with patient and begins followup. • Notifies radiologist that patient has been informed and follow-up begun, closing the “later” notification.

  5. “Later” notification Notification Sender PWP Notification Repository Notification Recipient “later” Event Reports finished Find Notification Method NAV Issue notification Log attempt (for NAV) Log receipt (for NAV) Responds with Acceptance Log Acceptance of responsibility Patient Interaction Reports results Log Acceptance of reports

  6. Find Information for critical results notification • Find Information • Who should be notified • How can they be notified • This will be relevant for both “Now” and “Later” notifications, but with perhaps different information needs. • Likely Approaches • PWP • Are additional fields needed or optionality affected?

  7. Find Information for critical results notification PWP Server Notification Information Query Actor ITI -24 Query/Display/ Report Requirements

  8. Reporting requirements • Log Notification Activity • Successful Notifications • Unsuccessful Notifications • Use of notification • Other? • Reporting • Notification Activity • Outstanding Notification Problems • Notification Information Query Actor • What queries are mandatory? Optional? How to handle extensibility? • What display capability is mandatory? Optional?

  9. Log Activity • Likely Standard: Syslog-TLS • Use ATNA? • ATNA reliability, access, and security needs can be different from the needs of logging notification activity • The decision whether to use the same server for both should be a deployment decision. • Federation requirement? • Schema must be defined, perhaps stealing a lot of content from ATNA.

  10. Log Activity ITI-XX1, Log Notification Activity Any Notification Activity Local Repository Central Repository ITI-XX1 Successes Failures Other Notification Log Query/Report Actor ITI-XX2, Query Notification Activity Time Period Patient Related Provider (person, group, etc.) Outstanding Issues Success/ Outstanding

  11. Notification Log Queries • Reporting • Notification Activity • Outstanding Notification Problems

  12. Notification methods • Notification methods • NAV (ITI-25, 26, 27, 28) • SMS • Voice • Fax • Pager • XDS • Other • What is appropriate and ready for IHE to specify in an interoperability profile? • Transports • Content Profile

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