erequesting and the electronic healthcare record
TRANSCRIPT
eRequesting and the EHRAnant Patel- Radiographer (SCoR Radiographers Informatics Group
CNWL NHS FT- Project Manager, Subject Matter Expert, Test Lead,
Consultancy, Supporting Not for Profit Organisations)
ampformatics.co.uk -
The Brief
eRequesting (concepts)
Hospital Information Systems (HIS)
Electronic Healthcare Records (EHR)
ampformatics.co.uk
What is Health Information (Informatics) Technology?
HEALTH is the GOAL INFORMATION adds VALUE TECHNOLOGY use of TOOLS
ampformatics.co.uk
Terminology EHR- Electronic Healthcare Record EPR- Electronic Patient Record- Hospital Based IRMER- Ionising Radiation (Medical Exposure) Regulations
PAS- Patient Administration System RIS- Radiology Information System LIMS- Laboratory Information Management
System HP- Health Portal- for patients and health services
ampformatics.co.uk
Drivers- Paperless by 2018 and 7 Day Working
NHS challenged to go paperless by 2018 (GDS 2013) – “to save billions, improve services and help meet the challenges of an ageing population”
Implementing 7 Day working in Imaging Departments: Good Practice Guidance (DoH 2012)- to utilise the resources of the NHS and to offer patients a more customer focussed service
Principle of safe staffing for radiography leaders (SoR 2015)- having an IT infrastructure which links across networks- streamlining practice
ampformatics.co.uk
Not just eRequesting
Awareness of Diagnostic Imaging interactions with other systems Hospital Information Systems
Hospital Information Systems
ampformatics.co.uk
Current understanding of eRequesting
Order Communications (Ordercomms) system Bi-directional communication/message with a
referrer containing:
Patient information (ID)
Clinical information
Progression of the examination
Image report/addendum
ampformatics.co.uk
Status Changes Requested Justified On Hold Scheduled Attended DNA Started
Completed Dictated Preliminary Final Addendum Report
viewed/acknowledged
ampformatics.co.uk
Diagnostic Requestors Hospitals and Clinics GP Practices Community/Mental/Sexual/District Health Private eReferral users ( possibly England/Northern
Ireland/Scotland/Wales)
ampformatics.co.uk
Benefits (1)
Track able by all users (status)
Routing to multi-sites/departments
Requests electronically audited (IRMER)
ampformatics.co.uk
Benefits (2)
Data collected legibly/ready for coding Real time demand possible via statistics Decision Support (e.g. RCR guidelines- iRefer)
along with could be added or duplicate checks Replaces need for scanned diagnostic requests
ampformatics.co.uk
Imaging User Considerations
Admin and Clerical- Registration/Scheduling (enterprise-wide)
Imaging Manager- Decisions/Activity Imaging Redesign- Any interested parties Vetting staff- Radiographers/radiologists IT Support- PACS/RIS and IT Manager RIS supplier- Various companies eRequest supplier- Various companies
ampformatics.co.uk
eRequesting Design Decisions Depends on software/suppliers unless
in-house/bespoke Current/Future flows mapped/agreed (work with supplier) Order Entry Format (OEF)- align with RIS/national codes
and be flexible:o Inpatient/outpatient/A&E/GPo Modality specific
Decision Support (duplicate/previous similar exam checks/ MBUR guidelines)
ampformatics.co.uk
eRequesting Not Just For Imaging Electronic Prescription Service-
o GPs and practice nurses - to send prescriptions electronically to a dispenser (such as a pharmacy) of the patient's choice.
o This makes the prescribing and dispensing process more efficient and convenient for patients and staff
Cardiology- similar to imaging Pathology x10 as many requests as imaging
o Hence pathology driven/collaborationo IRMER not to be forgotten
Roll out to other specialities, e.g. endoscopy
Clinical Systems talking to each other
Electronic Patient Record (Hospitals only)- not directly talking to external systems
Electronic Healthcare Record (Cradle to the Grave)- Linked up with external systems, but may not be fully integrated
Hospital Information Systems
Levels of Current State (majority paper-light)
Imaging- PAS/PACS/RIS (minimum) Imaging- PAS/PACS/RIS/VNA Order Entry- PAS/Ordercomms/PACS/RIS/VNA EPR- PAS/PACS/RIS/VNA +
Labs/Pharmacy/Scheduling EHR (almost)- EPR + Ext systems (Portals-
Clinical & Patient/ HIE/GP Systems including Ordercomms)
Integration (EPR)
Clinical Systems need to talk to each othero Pathology services- Collaboration the main oneo Cardiology/other diagnostics- Relatively easy to add ono IRMER- Blocker when Imaging is
added onto the other systems
Remember Suppliers Offer Products
(1) PACS/RIS Supplierso ‘Try’ to integrate (full System Integration Testing)o Though will end up with workarounds to achieve integrationo Suppliers getting better- need clinical & A&C input
(2) EPR/EHR Supplierso Try to sell their whole solution or componentso PACS/RIS suppliers may have better imaging solutions/integration but
does it benefit the EHR? (3) VNA- Any differences?
Trusts don’t have to be tied into suppliers
Integration Engines (using messaging)o Can join Clinical Information Systems (best of breeds)o Future Proof
• Trust (preferably imaging) must retain some control rather than the supplier or IT department
NOT JUST IMAGINGo Consider integrating with other systems (Labs/External/Patient)o Data for activityo NHS England- Open Source- “NHS England is drawing up plans to commit
millions, possibly tens of millions, of pounds from the £260m technology fund to funding open source software, potentially including an NHS version of VistA”, Digital Health (2015)
ampformatics.co.uk
ANY QUESTIONS?
ampformatics.co.uk
References Department of Health (2012).Implementing 7 Day Working in Imaging Departments: Good Practice Guidance.
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213707/dh_132083.pdf [Accessed 23rd June 2015]
Government Digital Service (2013). NHS Challenged to go Paperless by 2018. https://www.gov.uk/government/news/jeremy-hunt-challenges-nhs-to-go-paperless-by-2018--2 [Accessed : 22nd June 2015}
Nawanan T (2012). IT in Hospitals. [Online] Available from http://www.slideshare.net/nawanan/it-in-hospitals?from_action=save [Accessed : 19th June 2015]
RCR (2014). A Practical Guide to Implementing Ordercomms and electronic remote requesting http://www.rcr.ac.uk/docs/radiology/pdf/BFCR(14)1_Order_FINAL.pdf [Accessed : 22nd June 2015}
Society of Radiographers (2015). Principles of safe staffing for radiography leaders. https://www.sor.org/learning/document-library/principles-safe-staffing-radiography-leaders [Accessed 23rd June 2015]
ampformatics.co.uk
References
Belgium Museum of Radiology (2015). Wartime Advances Image. http://www.flanderstoday.eu/sites/default/files/webimages/ft343-p15-agenda_opener_0.jpg [Accessed 23rd June 2015]
Digital Health (2015). Open eyes to NHS open source. http://www.digitalhealth.net/insight/analysis/1122/open-eyes-to-nhs-open-source/ [Accessed 25th June 2015]