iSite 3.5: Exceptions Handling (RIS Version)

1. iSite 3.5: Exceptions Handling (RIS Version)

2. Table of Contents • Objectives • Terminology • Exception Definition • Exceptions Handler • Resolve Exception • Verify Resolution

3. Learning Objectives • Understand the purpose and performance of: • Exception Occurrence • Exceptions Handler • Building Exceptions List • Resolving Exceptions • Verifying Exceptions

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. Exception Resolution • Identify Exception • Worklist Module • Exceptions Handler Option • View Exception Images • Click on ID hyperlink • Click View • iSite will present matches based on MRN and Accession Number or the user may enter a known ACC (from RIS) and apply • Additional searches may be performed by clicking find pt/exam button • Click on the radio button next to patient’s record • Locate the Exam • Click on the MRN hyperlink • Verify Exam information and apply • Verify Resolution of Exception • Check patient folder • Check inactive/active lists

8. “Gold Standard” Patient Record • In a RIS integrated environment, the iSite database is populated with patient records and exams by HL7 messages • The record from the RIS is the record that iSite will consider the Gold Standard

9. Definition of an Exception • An exception is a study that contains patient or exam information from the modality which does not match patient demographic information residing within the iSite database for this patient or exam • DICOM Metadata, including MRN and/or Accession number, do not match the iSite database Gold Standard

10. Image Validation • All studies from modalities need to be validated prior to registration into the iSite database • Exceptions are studies that fail the automatic validation process and are identified with (!) an exclamation point in the Patient Directory • Exception studies require a MANUAL process to validate them into the database

11. Image Validation • iSite uses an interface (ConnectR) to automatically validate studies into the database • ConnectR looks at DICOM Metadata for images and validates the images with the corresponding exam ordered by the RIS HL7 Order Study (DICOM Metadata) iSite Database

12. Image Header Information • The Image DICOM Metadata information that ConnectR uses for validation in a RIS integrated environment are: • Medical Record Number • Accession Number

13. Image Header Information NAME MRN ACC # NAME MRN ACC # Diagnostic viewing workstation Modality (scanner) iSiteServer

14. Exception Occurrence in RIS Environment • DMWL (Dicom Modality Work List) was not used for some reason • HIS/RIS was down • Network or Connectivity Issue • Power Outage • System Reset • Periodic System Maintenance • Lack of full DICOM support at the modalities • Technologists must manually enter patient information • ACC not entered or entered incorrectly • Modality allows manual entry of MRN or ACC number, but it does not insert it into the DICOM Metadata

15. Exception Occurrence in RIS Environment • DMWL (Dicom Modality Work List) was not used for some reason • ER • Did not have time to order exam in RIS • No ACC number assigned when exam started • Workflow Error • ACC or Exam was cancelled while exam was in progress

16. Identifying Exceptions • In iSite Enterprise • Patient Directory (identify exceptions with an ‘!’ next to the patient’s name) • Worklist Filters • Exceptions Handler Folder • In iSuite • Exceptions Handler tab within the Worklist tab

17. Exceptions Handler • In iSuite or iSite Enterprise from the Folder List

18. Exceptions List • Select an Exceptions List

19. Exceptions List • A New Exceptions Worklist may be built

20. Exceptions List • Active or Inactive Status • Reason (e.g. ACC not found) • Patient Sex • Performing Resources

21. Exceptions List “Best Practices” • 2 Days is recommended for Date Range • ACQ and FIND are recommended for Type • Modality is recommended in most instances • To select a modality click the (…) button

22. Exceptions List • Select the modality from the pop-up Equipment Dictionary

23. Identifying Exceptions • An Additional Search may be made using Patient Name or Accession Number as well as other identifiers

24. Resolve Exceptions • An Exception may be resolved by selecting the ID hyperlink

25. Resolve Exceptions • View the image by selecting the ‘View’ button

26. Resolve Exceptions • Images of poor quality may be removed by selecting the ‘remove’ button

27. Resolve Exceptions • iSuite conducts a Database search for a matching MRN (Patient ID) and ACC (Accession Number)

28. Resolve Exceptions • Locate the Patient’s Record/Exam

29. Resolve Exceptions • Select the correct Accession Number to which the images belong

30. Resolve Exceptions • If ACC number is known it may be entered in the field • ACC number entered must represent a valid exam that the RIS ordered or it will be rejected

31. Resolve Exceptions • ‘find pt/exam’ may be used to perform additional searches

32. Resolve Exceptions • iSuite conducts a Database search for a Name, although additional searches may be made

33. Resolve Exceptions • Select the ‘apply’ button

34. Resolve Exceptions • Resolve the Exception by confirming the selection

35. Exception Resolution Verification • Verify the Exception is now in the ‘Inactive’ Exception List and no longer in the ‘Active’ Exception List

36. Exception Resolution Verification In iSite Enterprise verify: • Exception with the “!” is no longer there • Exception’s Images or study are now part of the patient’s original folder

37. Exception Resolution • Identify Exception • Worklist Module • Exceptions Handler Option • View Exception Images • Click on ID hyperlink • Click View • iSite will present matches based on MRN and Accession Number or the user may enter a known ACC (from RIS) and apply • Additional searches may be performed by clicking find pt/exam button • Click on the radio button next to patient’s record • Locate the Exam • Click on the MRN hyperlink • Verify Exam information and apply • Verify Resolution of Exception • Check patient folder • Check inactive/active lists

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