Radiology and order comms custom statuses Paul Davison

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

The Tools • Radiology RIS system – – – HSS CRIS version 1. 06. 12 t Southern cluster shared instance – SHA 1 Order comms interface from original LSP deployment offering • Order Communications system – Sunquest ICE Release July 09. 1/Version 391 (about to upgrade to Alpine)

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

ICE CRIS interactions • Order status depends on HL 7 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

HL 7 - Order Control Messages • Possible order status messages CRIS ICE: Message Type Order Control Status ORC: 1 ORC: 5 Meaning OMG^O 19 NW SC New order booked on CRIS, appointment booked IP New order booked on CRIS, patient in dept SC Status change, appointment booked IP Status change, patient in dept CM Status change, examination performed CA CA Order cancelled XO SC Order changed, appointment booked IP Order changed, patient in dept SC

HL 7 Message examples MSH|^~&|CRIS|LIVE|GE||20051014112020||OMG^O 19|10016261|P|2. 4 PID|||0471579^^^RNZ 02^MR~420 449 8396^^^NHS^NH~10001041^^^CRIS^PI||RICE^DAVID^^^MR||19430310|M|||39 CLOUGHS ROAD^RINGWOOD^HAMPSHIRE^^BH 24 1 UU||01425 473240 / 01425 4712~||||||||""|N PD 1|||^^J 82039|G 3367427 PV 1|||||||||A ORC|NW||10001292^CRIS||SC||^^^200510141119^^1||200510141119|CRIS||C 3142130^KIRKPATR ICK JNP|RNZ 02 BURN||||130|alanstibook|CRIS||^^RNZ 02 OBR|||10001292^CRIS|CCALL^CT Calcaneum Lt||||||||10001231|RNZ 10001292|||C|||^^^200510141119^^1|||||||^^^^^^RNZ 02 MSH|^~&|CRIS|LIVE|GE||20051014112050||OMG^O 19|10016285|P|2. 4 PID|||0471579^^^RNZ 02^MR~420 449 8396^^^NHS^NH~10001041^^^CRIS^PI||RICE^DAVID^^^MR||19430310|M|||39 CLOUGHS ROAD^RINGWOOD^HAMPSHIRE^^BH 24 1 UU||01425 473240 / 01425 4712~||||||||""|N PD 1|||^^J 82039|G 3367427^MPV 1|||||||||A ORC|SC||10001293^CRIS||CM||^^^200510141119^^1||200510141120|CRIS||C 3142130^KIRKPATR ICK JNP|RNZ 02 BURN||||130|alanstibook|CRIS||^^RNZ 02 OBR|||10001293^CRIS|CCALR^CT Calcaneum Rt||||||||10001231|RNZ 10001293|||C|||^^^200510141119^^1|||||||CRIS&Cris user^^^^XMR^^RNZ 02

Requesting CRIS ICE requests Radiology processes (paper heavy) Electronic ‘order’ created in ICE by Trust staff REQ – requested status RCV – received status ‘OK’ Message Instant Electronic ‘order’ on CRIS 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 F – Final report status Verified report Batch printing of results and distribution of reports

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

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 HL 7 messages to send more status messages – Mapping new CRIS status messages in ICE

CRIS Custom status mapping • HSS can customise ORC: 5 segment in CRIS HL 7 – 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 HL 7 message • Mapped to new order status in ICE

Requesting CRIS ICE requests Radiology processes (now paper light) Electronic ‘order’ created in ICE by Trust staff REQ – requested status Electronic ‘order’ on CRIS 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) Accepted request on CRIS ACC – accepted status Waiting Pending APT – appointment status Appointment made ATT – attended status Patient attends Accepted requests filtered by A&C staff Request printout used for ID EXM – examined status Patient examined RR – Results received status VR reporting Reporting F – Final report status Electronic sign off Verified report

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