isite 3.5: demographic mismatches

iSite 3.5: Demographic Mismatches

CONFIDENTIAL 2TRN-0035-15 Rev 06/23/06

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)


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)


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


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


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


Demographics Mismatch Overview


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


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


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


NO

Study received by server.

Detection level?Name or DOB different as well as ID?

Level 1

YES

Level 2

NO

No Dup Case. Study merged with existing

patient.

AutoGenerate enabled?YESAny AE Titles specified?YESSending AE Title on list?

New study UID generated from SUID + MRN, regardless of dup status.

Uses demographics from incoming study.

NO

NO

NO

Dup Case in System. Email sent to PACS

admin. Study hung w/ existing study. All series in

study display warning msg.

YES

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 Patient ID match existing study patient ID?

YES

Continue with rest of consolidation process.

NO

Does Study UID already exist on server?

YES

Demographics Mismatch Detection


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


DUPUID Case Folder

• The DUPUID Cases Folder provides a historical reference of Demographic Mismatches for the iSite PACS Administrator


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


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


Hide 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 “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


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


• 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



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



• 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



• 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



• 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


Digital Image Management: 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

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

Detaching Images from an Order


Sys Admin Module• Click the Sys Admin module

Step 1


Sys Admin Module• Click the Digital Img Mgmt option

Step 2


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

Step 3


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


Sys Admin Module• Deselect the check box next to the Study Instance Unique Identifier

Step 4


Sys Admin Module• Click the detach button to detach the study from the exam

Step 5


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


Delete Image(s)


Delete Image(s)• Images may be deleted by “right clicking” on an image and selecting

‘Delete’ from the Context Menu


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


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


Recover Deleted Images• Deleted Images may be recovered by “right clicking” the Exam Rack Shelf

Bar and selecting “Recover Deleted Images”


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


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


For assistance, please call customer support at

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

isite 3.5: demographic mismatches

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