iSite 3.5: Demographic Mismatches

1. iSite 3.5: Demographic Mismatches

2. Table of Contents • Objectives • Terminology • Demographics Mismatch Overview • Hide Demographics Mismatch • Remove Demographics Mismatch • Assign New Study Instance Unique Identifier • Detach Images from an Order • Delete Image(s)

3. Objectives • Understand Demographic Mismatches (Duplicate Study Instance Unique Identifiers or Dup UIDs) • Understand the use of Remove Demographics Mismatch • Understand the use of Assign New Study Instance Unique Identifier • Understand the use of Delete Image(s)

4. 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

5. 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

6. 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

7. Demographics Mismatch Overview

8. Demographics Mismatch • A Demographics Mismatch (Duplicate Study Instance Unique Identifier or Dup UID) is an event where a single study (as identified by a single Study Instance Unique Identifier) has more than one set of associated patient demographics • A Demographics Mismatch is a study which contains images with patient demographic discrepancies but contains the same study unique identifiers (SUID) • Upon detection of this error, notification is presented to the iSite PACS Administration team for action

9. Demographics Mismatch • iSite offers a set of tools to allow an iSite Administrator to resolve Demographic Mismatches • These tools can also be used to resolve workflow errors that may not necessarily generate a Demographics Mismatch scenario • It is not uncommon due to noncompliant modalities or technologists’ workflow errors that two studies with different patient demographic information are assigned the same SUID • When this happens the images are merged into a single study

10. Demographics Mismatch Occurrence • Noncompliant Modalities: • When certain modalities are upgraded, the SUID counter may be reset • Any “new” SUID will be a duplicate of a previous one prior to the upgrade • Technologist Workflow Errors: • A technologist scanned in a patient with the wrong patient demographics and sends the study to iSite with a specific SUID • The technologist realizes the mistake and corrects the patient demographics on the modality console prior to resending the study which maintains its previous SUID

11. Study received by server. Sending AE Title on list? AutoGenerate enabled? Any AE Titles specified? NO YES YES YES NO NO New study UID generated from SUID + MRN, regardless of dup status. Uses demographics from incoming study. Important Note: At this point the study will either have the original UID or the generated UID. If a new UID was generated, it will be used for all dup UID comparisons, not the original UID. This ensures that generated study UIDs will never have a dup UID condition. Does Study UID already exist on server? YES NO Does Patient ID match existing study patient ID? YES NO NO Level 1 Detection level? Level 2 YES Dup Case in System. Email sent to PACS admin. Study hung w/ existing study. All series in study display warning msg. Continue with rest of consolidation process. No Dup Case. Study merged with existing patient. Name or DOB different as well as ID? Demographics Mismatch Detection

12. Demographics Mismatch Email Notification • An automatic email will be sent from the iSite server directly to the main iSite PACS Administrator at the customer site when a Demographics Mismatch is detected

13. DUPUID Case Folder • The DUPUID Cases Folder provides a historical reference of Demographic Mismatches for the iSite PACS Administrator

14. Demographics Mismatch Warning Message • The merged studies will be displayed in iSite with a Warning Message overlaying the images to warn users of the possibility of viewing a study with images/series from different patients

15. DUP UID Toolset • iSite PACS Administrators to perform the following whenever there are merged studies with patient demographic discrepancies due to Demographic Mismatches: • Delete any series which do not belong to the study • Assign New Unique Study UID to the specific series which do not belong with the rest of the study. These images can later be validated with another patient’s exam • Remove Demographics Mismatch is a resolution measure which will accept existing study’s patient demographics and merge the duplicate UID series • Hide Demographics Mismatch option is for end users to temporary turn off the warning message while navigating the study

16. Hide Demographics Mismatch

17. This feature is accessed by right clicking on a series thumbnail within a study rack or on a pop up window The option to “Hide Demographics Mismatch” will only be available if the study contains multiple varying patient demographics This feature is only available if the user DOES NOT have the Security Code: ISTRDUPID Hide Demographics Mismatch

18. Remove Demographics Mismatch

19. Remove Demographics Mismatch • Demographics Mismatch Case: • A radiologic technologist acquired images and discussed additional views or sequences with the radiologist • Upon review, the radiologist requests additional views • The radiologic technologist then inadvertently mistypes the patient demographics • Resolution: • Use the “Remove Demographics Mismatch” feature on the additional views to resolve the demographics mismatch and keep the demographics provided by the first set of images

20. Remove Demographics Mismatch • This feature is accessed by right clicking on a series thumbnail within a study rack or on a pop up window • The option to “Remove Demographics Mismatch” will only be available if the study contains multiple varying patient demographics • This feature is only available if the user has the Security Code: ISTRDUPID

21. Assign New Unique Study UID

22. Assign New Unique Study UID • This feature is accessed by right clicking on a series thumbnail within a study rack • The option to “Assign New Unique Study UID” will only be available if there is more than one series in any particular study • This feature is only available if the user has the Security Code: ISTRDUPID

23. Assign New Unique Study UID • Demographics Mismatch Case: • A radiologic technologist acquired images for multiple patients • The radiologic technologist mistakenly identifies all image cassettes as images for one specific patient’s demographics (Patient A) into the console • This is not a Demographics Mismatch because all images will have the same demographics (Patient A) • Resolution: • Use the “Assign New Unique Study UID” to have iSite generate a new SUID for the series (Patient B) that should be assigned to Patient B • Use Digital Image Management to disassociate the series (Patient B) from the rest of the exam • Resolve exception images to the Patient B record

24. Assign New Unique Study UID • Demographics Mismatch Case: • A radiologic technologist acquired images for a patient • The radiologic technologist did not “complete” the study on the modality • The radiologic technologist enters new patient demographics for the next patient and begins acquiring images • The modality did not assign a new Study Instance Unique Identifier; therefore, the studies will have the same SUID • This is a Demographics Mismatch • Resolution: • Use the “Assign New Unique Study UID” to have iSite generate a new SUID for the series (Patient B) that should be assigned to Patient B • The Assign New Unique Study UID feature will attempt to validate and resolve the images with a corresponding record or the images will not resolve and will be exceptions • Resolve exception images to Patient B’s record

25. Assign New Unique Study UID • Ultrasound Demographics Mismatch Case: • A sonographer acquired images for a patient • The sonographer did not “complete” the study on the modality • The sonographer enters new patient demographics for the next patient and begins acquiring images • The modality did not assign a new Study Instance Unique Identifier; therefore, the studies will have the same SUID • This is a Demographics Mismatch; however, the images must be separated (split) before a new Study Instance Unique Identifier may be assigned • Resolution: • Use the “split exam” feature to un-stack the images • Use the “Assign New Unique Study UID” to have iSite generate a new SUID for the series (Patient B) that should be assigned to Patient B • The Assign New Unique Study UID feature will attempt to validate and resolve the images with a corresponding record or the images will not resolve and will be exceptions • Resolve exception images to Patient B’s record

26. Digital Image Management: Detaching Images from an Order

27. Detaching Images from an Order • At times, it may be necessary to detach a study from an exam • For example, if images belonging to one patient’s record are accidentally assigned to another patient’s exam, you will have to detach the images from the incorrect exam and reassign them to the correct patient’s exam • This involves detaching a study or studies from a patient’s exam record, thereby creating an exception, and then resolving the resulting exception by assigning it to the correct patient’s exam

28. Detaching Images from an Order • Log into iSuite (the administrative application of iSite) and follow these steps to detach images from a patient’s record

29. Sys Admin Module • Click the Sys Admin module Step 1

30. Sys Admin Module • Click the Digital Img Mgmt option Step 2

31. Sys Admin Module • Search for the exam by Accession Number, MRN or patient name, etc. Step 3

32. Sys Admin Module • The images may be viewed by clicking the view button

33. Sys Admin Module • Deselect the check box next to the Study Instance Unique Identifier Step 4

34. Sys Admin Module • Click the detach button to detach the study from the exam Step 5

35. Sys Admin Module • A verification dialog is presented • The selected study will become an exception

36. Delete Image(s)

37. Delete Image(s) • Images may be deleted by “right clicking” on an image and selecting ‘Delete’ from the Context Menu

38. Delete Image(s) • A Reason must be selected from the list presented

39. 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 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

40. Recover Deleted Images • Deleted Images may be recovered by “right clicking” the Exam Rack Shelf Bar and selecting “Recover Deleted Images”

41. 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

42. 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

43. For assistance, please call customer support at 1-877-328-2808 or 1-877-328-2809