Transcript Introduction

Picture Archiving and Communications System (PACS)
Cerner Millennium:
Integration with RIS and PACS
UK PACS & Teleradiology Group
Newquay, March 30th 2007
Roger Irish, Maggie Nicholls
March 2007
Picture Archiving and Communications System (PACS)
Contents
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Introduction
Overview of Millennium integration with PACS and RIS
Order Communications Project Issues
Order Communications in other Clusters
Questions
Picture Archiving and Communications System (PACS)
Introduction
• Overview of the integration between Cerner Millennium
and GE PACS and HSS CRIS in the South
• Focus is primarily upon Order Communications, but
encompasses all integration points
• Provides an update on the Order Communications
Project and its findings
• Concludes with a brief overview of Order
Communications support in other regions
Picture Archiving and Communications System (PACS)
Interface Overview
• Basis for Order Communications in the South is the
Cerner Millennium interface deployed at Newham &
Homerton (East London)
• Overview focuses primarily on the scope of this
interface
• Overview covers Demographic Changes (via ADT
messages) and Orders (Requests) (via the Order
Communications interface
Picture Archiving and Communications System (PACS)
Integration Architecture between CRS
and RIS
CRS to RIS Communication
CRS Domain 1
RIS Domain A
CRS Entity P
RIS Entity P
CRS Entity Q
RIS Entity Q
CRS Entity R
RIS Entity R
CRS Domain 2
RIS Entity S
• Each entity / Deployment
family in CRS communicates
to its equivalent entity in RIS
• Communication is not at the
domain level
• This is true for demographics
(ADT) and orders (ORM)
CRS Entity S
RIS Domain B
CRS Entity T
RIS Entity T
CRS Entity U
RIS Entity U
CRS Entity V
RIS Entity V
• There are:
– 10 CRS domains
– 7 RIS domains
Picture Archiving and Communications System (PACS)
Overview of Demographic Propagation
CRS to RIS Communication
CRS Domain 1
RIS Domain A
ADT
CRS Entity P
RIS Entity P
CRS Entity Q
RIS Entity Q
CRS Entity R
RIS Entity R
RIS Entity S
CRS Domain 2
• Demographic changes are
sent from CRS to departmental
systems using messages in
the ADT interface set
• Communication is not at the
domain level
ADT
CRS Entity S
RIS Domain B
CRS Entity T
RIS Entity T
ADT
CRS
Entity U
RIS Entity U
CRS Entity V
RIS Entity V
• Each entity in CRS
communicates to its equivalent
entity in RIS
Picture Archiving and Communications System (PACS)
Order communication data flow
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Place request on CRS
Request processed on RIS
Appointment is scheduled
Patient presents
Imaging carried out
Imaging verified
Imaging Reported
Report Verified
Event
Event
Requested
Accepted
Attended
Provisional
Complete
Ordered
Ordered (Complete)
Complete
CRS
RIS
Picture Archiving and Communications System (PACS)
Image Viewing in Cerner Millennium R2
• The Order Communications results feed from CRIS to
Millennium serves a dual purpose:
– Passes report in support of the longitudinal patient history held in
CRS
– Passes a link to the associated imaging in the cluster data store
• Cerner Millennium Release 2 will include functionality to
invoke the Centricity Enterprise Web Viewer from within
PowerChart / PowerChart Outreach
• This will allow the viewing of relevant PACS images from
within Millennium
Picture Archiving and Communications System (PACS)
The Southern Cluster Order
Communications Project
• This was initiated in January 2007 in response to
concerns raised by the Southern Cluster RIS/PACS
clinicians, that the Order Communications functionality
being offered as part of the R0/R1 releases of Cerner
Millennium, may not fully meet the clinical and business
requirements of Pathology and Radiology departments.
Picture Archiving and Communications System (PACS)
Summary of Findings
Priority for Resolution
Clinical
Priority
High
4
5
24
Medium
4
2
1
Low
9
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Yes – Long Term/No
workaround
required
Yes – Short Term
No
Acceptable Workaround Available?
• Issues have not been assessed against requirements to determine if
they are defects or change requests
• Cerner resource enabled several issues to be closed
Picture Archiving and Communications System (PACS)
Summary of Issue Progression Route
Route
Number of Issues
Refer to Requirements Definition Group
18
Design Requirements Authority Action
7
Refer to R2 Design Groups
5
Review by Technical Architects
4
Deployment Team Action
6
Change Board Action
1
Orderables Project Action
4
None Required
8
Picture Archiving and Communications System (PACS)
Unsolicited Results
• Unsolicited Results are required to support:
– GP Requests
– Paper requests from downtime
– Independent Sector requests where results are transcribed into the
CRIS, but where the request may not have originated in Cerner
Millennium
• CCN written due to be submitted to Requirements Group 21.03.07
with view to submission to Change Board within next week. (This
covers 6 scenarios which require unsolicited results)
Picture Archiving and Communications System (PACS)
Status Update
• Required to indicate to the end user that a request has
been scheduled inc. date & time of appt (i.e. an update
to the request status showing when an appointment has
been scheduled in the Radiology System)
• Raise through Requirements Definition Group for
assessment with view to supporting receipt of a status
update against a radiology request in Millennium to
indicate the request has been 'Scheduled' , with the
ability to display appointment date & time
Picture Archiving and Communications System (PACS)
Cancellation of Radiology
Appointments
• Once Radiology requests are submitted by the user (signed) they
can only be cancelled via the RIS system
• Short Term workaround is for users to contact the Radiology
Department to request the item be cancelled
• Could result in unnecessary exposure to radiation if requests are
performed before the user can be contacted to cancel
• There is also no audit trail available by this method to indicate who
requested the cancellation
• Raise through Requirements Definition Group for assessment
Picture Archiving and Communications System (PACS)
Imaging Request Routing
• Current thinking regarding interface design does not
take into account the level of flexibility needed to route
groups of orders to different services within a single trust
or between trusts within the same domain
• This issue has already been raised at the DRA. This
issue needs further discussion
Picture Archiving and Communications System (PACS)
PowerChart Inbox Proxy Settings
• Requestor is not available to sign off a result
• Workaround to proxy access to inbox was deemed
acceptable short term
• For the longer term, work is required to ensure future
design considers the concept of teams sending
notification to all team members and the concept of
deferring inbox contents e.g. when on leave
• Raise for inclusion in future design (R2) to support team
working and inbox deferral
Picture Archiving and Communications System (PACS)
Other Clusters – North West and West
Midlands
• iSoft LE 2.1 and HSS CRIS
• iSoft i.CM supports all the Order Communications
messages that HSS CRIS can process
• iSoft i.PM supports the patient demographics and admit
/ discharge messages
• i.CM Results Reporting supports unsolicited results
Picture Archiving and Communications System (PACS)
Other Clusters – North East and East
Midlands
• Have same NCRS solution as NWWM, namely iSoft
• There is no contracted / LSP RIS solution, so trusts are
at liberty to choose their own
• There have been trust implementations of HSS CRIS
(standalone)
• Order Communications functionality is similar to that in
the NWWM
Picture Archiving and Communications System (PACS)
Other Clusters – London
• Are taking Cerner Millennium, initially based on the
Southern Region solution (R0)
• Have a tactical RIS solution (iSoft RadCentre), no
strategic RIS
• Order Communications functionality is not yet fully
agreed
Picture Archiving and Communications System (PACS)
Questions