isite 3.5: exceptions handling (ris version)

iSite 3.5: Exceptions Handling (RIS Version)

CONFIDENTIAL 2TRN-0035-14 Rev 06/23/06

Table of Contents

• Objectives

• Terminology

• Exception Definition

• Exceptions Handler

• Resolve Exception

• Verify Resolution

CONFIDENTIAL 3TRN-0035-14 Rev 06/23/06

Learning Objectives

• Understand the purpose and performance of:

– Exception Occurrence

– Exceptions Handler

– Building Exceptions List

– Resolving Exceptions

– Verifying Exceptions

CONFIDENTIAL 4TRN-0035-14 Rev 06/23/06

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

CONFIDENTIAL 5TRN-0035-14 Rev 06/23/06

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

CONFIDENTIAL 6TRN-0035-14 Rev 06/23/06

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

CONFIDENTIAL 7TRN-0035-14 Rev 06/23/06

Exception Resolution

1. Identify Exception1. Worklist Module2. Exceptions Handler Option

2. View Exception Images1. Click on ID hyperlink2. Click View

3. iSite will present matches based on MRN and Accession Number or the user may enter a known ACC (from RIS) and apply1. Additional searches may be performed by clicking find pt/exam button2. Click on the radio button next to patient’s record

4. Locate the Exam1. Click on the MRN hyperlink 2. Verify Exam information and apply

5. Verify Resolution of Exception1. Check patient folder2. Check inactive/active lists

CONFIDENTIAL 8TRN-0035-14 Rev 06/23/06

“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

CONFIDENTIAL 9TRN-0035-14 Rev 06/23/06

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

CONFIDENTIAL 10TRN-0035-14 Rev 06/23/06

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

CONFIDENTIAL 11TRN-0035-14 Rev 06/23/06

ACC … SUID

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

CONFIDENTIAL 12TRN-0035-14 Rev 06/23/06

Image Header Information

• The Image DICOM Metadata information that ConnectR uses for validation in a RIS integrated environment are:

• Medical Record Number• Accession Number

CONFIDENTIAL 13TRN-0035-14 Rev 06/23/06

Image Header Information

Modality (scanner)

Diagnostic viewing

workstation

iSite Server

NAMEMRNACC #

NAMEMRNACC #

CONFIDENTIAL 14TRN-0035-14 Rev 06/23/06

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

CONFIDENTIAL 15TRN-0035-14 Rev 06/23/06

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

CONFIDENTIAL 16TRN-0035-14 Rev 06/23/06

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

CONFIDENTIAL 17TRN-0035-14 Rev 06/23/06

• In iSuite or iSite Enterprise from the Folder List

Exceptions Handler

CONFIDENTIAL 18TRN-0035-14 Rev 06/23/06

Exceptions List• Select an Exceptions List

CONFIDENTIAL 19TRN-0035-14 Rev 06/23/06

Exceptions List• A New Exceptions Worklist may be built

CONFIDENTIAL 20TRN-0035-14 Rev 06/23/06

Exceptions List

• Active or Inactive Status

• Reason (e.g. ACC not found)

• Patient Sex

• Performing Resources

CONFIDENTIAL 21TRN-0035-14 Rev 06/23/06

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

CONFIDENTIAL 22TRN-0035-14 Rev 06/23/06

Exceptions List

• Select the modality from the pop-up Equipment Dictionary

CONFIDENTIAL 23TRN-0035-14 Rev 06/23/06

Identifying Exceptions• An Additional Search may be made using Patient Name or Accession

Number as well as other identifiers

CONFIDENTIAL 24TRN-0035-14 Rev 06/23/06

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

CONFIDENTIAL 25TRN-0035-14 Rev 06/23/06

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

CONFIDENTIAL 26TRN-0035-14 Rev 06/23/06

Resolve Exceptions• Images of poor quality may be removed by selecting the

‘remove’ button

CONFIDENTIAL 27TRN-0035-14 Rev 06/23/06

Resolve Exceptions• iSuite conducts a Database search for a matching MRN (Patient ID)

and ACC (Accession Number)

CONFIDENTIAL 28TRN-0035-14 Rev 06/23/06

Resolve Exceptions• Locate the Patient’s Record/Exam

CONFIDENTIAL 29TRN-0035-14 Rev 06/23/06

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

CONFIDENTIAL 30TRN-0035-14 Rev 06/23/06

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

CONFIDENTIAL 31TRN-0035-14 Rev 06/23/06

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

CONFIDENTIAL 32TRN-0035-14 Rev 06/23/06

Resolve Exceptions• iSuite conducts a Database search for a Name, although additional

searches may be made

CONFIDENTIAL 33TRN-0035-14 Rev 06/23/06

Resolve Exceptions• Select the ‘apply’ button

CONFIDENTIAL 34TRN-0035-14 Rev 06/23/06

Resolve Exceptions• Resolve the Exception by confirming the selection

CONFIDENTIAL 35TRN-0035-14 Rev 06/23/06

Exception Resolution Verification

• Verify the Exception is now in the ‘Inactive’ Exception List and no longer in the ‘Active’ Exception List

CONFIDENTIAL 36TRN-0035-14 Rev 06/23/06

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

Exception Resolution Verification

CONFIDENTIAL 37TRN-0035-14 Rev 06/23/06

Exception Resolution

1. Identify Exception1. Worklist Module2. Exceptions Handler Option

2. View Exception Images1. Click on ID hyperlink2. Click View

3. iSite will present matches based on MRN and Accession Number or the user may enter a known ACC (from RIS) and apply1. Additional searches may be performed by clicking find pt/exam button2. Click on the radio button next to patient’s record

4. Locate the Exam1. Click on the MRN hyperlink 2. Verify Exam information and apply

5. Verify Resolution of Exception1. Check patient folder2. Check inactive/active lists

CONFIDENTIAL 38TRN-0035-14 Rev 06/23/06

For assistance, please call customer support at

1-877-328-2808 or 1-877-328-2809